Hawaii Biotechnology Research: Interest Areas and Opportunities with the Department of Defense COL Karl Friedl, PhD Telemedicine & Advanced Technology Research Center US Army Medical.

Transcript Hawaii Biotechnology Research: Interest Areas and Opportunities with the Department of Defense COL Karl Friedl, PhD Telemedicine & Advanced Technology Research Center US Army Medical.

Slide 1

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 2

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 3

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 4

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 5

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 6

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 7

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 8

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 9

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 10

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 11

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 12

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 13

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 14

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 15

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 16

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 17

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 18

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 19

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 20

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 21

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 22

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 23

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 24

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 25

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 26

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 27

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 28

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 29

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 30

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 31

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 32

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 33

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 34

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 35

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 36

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 37

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 38

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 39

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 40

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 41

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 42

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 43

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 44

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 45

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 46

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 47

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Slide 48

Hawaii Biotechnology Research:
Interest Areas and Opportunities
with the Department of Defense

COL Karl Friedl, PhD

Telemedicine & Advanced Technology Research Center
US Army Medical Research & Materiel Command
Frederick, MD
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 1 of 48

A hiatus exists between the inventor
who knows what they could invent, if
they only knew what was wanted,
and the soldiers who know, or ought
to know, what they want and would
ask for it if they only knew how much
science could do for them.
- Winston S. Churchill (1929)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 2 of 48

Agenda
• Military medical research interests
• Biomedical research in the DoD

• USAMRMC organizational structure
• Competitive funding opportunities

• Hawaii Federal Healthcare Network Program

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 3 of 48

Technology Shortfalls: Fill the Gaps
Current Operational
Concepts and
Environment

Future Operational
Concepts and
Environment

Needed S&T Work

S&T
Shortfalls

Needed S&T Work

Ongoing S&T
Work

Existing Tech or
Non-Technology
Solutions

Capability Needs

Capability Challenges

Desired Capabilities

Existing Tech or
Non-Technology
Solutions
Capability Today
Capability Today

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 4 of 48

The Linear Approach to R&D
Army Medical Product Development Life Cycle
Fed / DoD Needs

ICD

ICD

CDD

CPD

Opportunities, Gaps, & Resources

Funding

Life Cycle

MDD

6.1

A

6.2

B

6.3

6.4

Research, Development, Test, & Evaluation (RDT&E) $

DoD Funding Categories
6.1 – 6.3: Basic research, applied research, and advanced technology development
6.4 – 6.5: Program management activities
6.6: Program support including test and evaluation facilities
6.7: Improvements to existing operational systems
Joint Capability Integration & Development System Documents
ICD: Integrated Capabilities Documents
CDD: Capability Development Documents
CPD: Capability Production Documents

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Program
Management
Initiation

6.5

C

6.7
Procurement $

Ops &
Maint $

Vannevar Bush model
Basic research is a
pacemaker of technological
innovation but must be
segregated to avoid
premature thoughts of
practical use

UNCLASSIFIED

Slide 5 of 48

DoD Problem-solving Focus:
Use-inspired Medical Research
Understanding underlying science creates rule base to help solve
future problems

Low Emphasis on
Fundamental
Understanding

Revolutionary
Pure basic
research (Bohr)

Low Emphasis
on Applications

High Emphasis
on Applications

High Emphasis on
Basic Science

Pure applied
research
(Edison)

Use-inspired
basic research
(Pasteur)

Evolutionary
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 6 of 48

What are the DoD Medical
Research Priorities?
(Where do they come from?)

• National strategic plans (e.g., Quadrennial
Review – in progress!)
• Secretary of Defense & other authoritative
sources in the DoD and Services
• Armed Services Biomedical Research
Evaluation and Management
• Near-term problems identified by field
commanders & COCOMs
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 7 of 48

Secretary Gates' Press Briefing
May 3, 2007
Apart from the war, this department
and I have no higher priority than to
ensure wounded servicemembers
have the best care and facilities and
ample assistance navigating the next
step in their lives. That is what we
intend to give them.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 8 of 48

Current Priorities:
Secretary Gates' Budget Briefing
April 6, 2009

Recognize the critical and permanent
nature of wounded, ill and injured,
traumatic brain injury, and
psychological health programs.
This means institutionalizing and
properly funding these efforts in the
base budget and increasing overall
spending by $300 million. The
department will spend over $47 billion
on healthcare in FY10.
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 9 of 48

Enduring Challenges:
Old Medical Threats, New Science
LIMB LOSS

SHELL SHOCK

HEMORRHAGE
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 10 of 48

Core Medical R&T Responds to Threats
to Soldier Health and Performance
Endemic Disease Threats
• Parasitic Diseases
• Bacterial Diseases
• Viral Diseases

Operational Stressors
• Sleep Deprivation
• Traumatic Stress and
Situational Stressors
• Physical Work Load
• Cognitive Burden &
Operational Complexity

Chemical/Biological
Warfare Threats
• Bacterial Threats
• Viral Threats
• Toxin Threats
• Nerve Agents
• Vesicant Agents
• Blood Agents

Environmental Hazards
• Heat and Cold
• Altitude
• Toxic Industrial
Chemicals & Materials

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Combat Injuries
• Hemorrhage
• Head Trauma
• Blast Injury

Inadequate
Medical C4ISR

UNCLASSIFIED

Systems Hazards
• Laser
• Blast
• Biomechanical
Insults and Stresses
• Noise

Slide 11 of 48

Pharmaceutical Advanced Development
Pipeline at USAMMDA
Pre-Clinical

Phase 1

Phase 2

Phase 3

Licensed

VACCINES
(License
Submitted)
(Proof-of-Concept Completed)

Adenovirus Type 4 & 7
HIV Prime-Boost

(Proof-of-Concept)

Dengue Tetravalent
ANTIPARASITIC DRUGS/Dx
Leish Drug, PentostamTM
Antimalarial-IV Artesunate
Topical Leishmania Drug
Antimalarial-Tafenoquine

(Proof-of-Concept)

Leish Rapid Diagnostic
COMBAT CASUALTY CARE
Intranasal Ketamine
RBCs Extended Life
Cryopreserved Platelets

Freeze-Dried Plasma
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 12 of 48

Joint Force Health Protection Capability
Gap Medical R&D
OVERARCHING
NEEDS:

Maintain a Healthy & Fit Force
Protect Personnel in the Field

Military Infectious Diseases Research Program

Medical Biological Defense Research Program
Vaccines and pre-treatments
Small molecule therapeutics
Next generation diagnostics
Animal model development
Broad-spectrum therapeutics

Vaccines
Prophylaxis/treatment drugs
Diagnostics/prognostics
Vector control
HIV countermeasures (Congressional mandate)

Medical Chemical Defense Research Program

Combat Casualty Care Research Program

Nerve agent pre-treatments
Therapeutics for nerve agents
Therapeutics for vesicant injury
Diagnostic assays/technologies

Meet Demands on First Responders
Reduce the Number of Deaths on the Battlefield
Limit Brain Damage
Improve Medic, Provider, and Team Training
Restore Full Function
Improve En Route Care
Reduce Morbidity and “Died of Wounds” Rate
Clinical Trials

Clinical and Regenerative Medicine Research Program
Improve Prosthetic Function
Enhance Self Regenerative Capacity
Improve Limb/Organ Transplant Success
Create Fully-Functioning Limbs/Organs

Military Operational Research Program

Blast Injury Program Coordinating Office

Prevent, Detect and Treat Mental Health Problems and mTBI
(Concussion)
Prevent/Mitigate Blast, Blunt, Ballistic, and Impact Injury
Reduce Attrition in Basic Combat Training Due to Injury and
Mental Health Problems
Prevent/Mitigate Injury from Environmental Exposures to
Heat/Cold/Altitude and Toxic Chemicals and Materials
Sustain
Soldier
Performance(301-619-7967) (DSN 343)
COL Karl
Friedl/MCMR-TT

Develop Medical Standards for Individual and Combat
Vehicle Crew Blast Protection Systems
Elucidate the Mechanism of Blast-Induced Brain Injury
Improve Diagnosis of mTBI
Effectively Communicate Blast-Related Research Across the
DoD
Reset
Advance Treatment Options

UNCLASSIFIED

[email protected]

Diagnosis for Early Treatment
Rapid Return to Duty

Slide 13 of 48

Key Blast Injury Research Topics
(FY07-10 Investments)

Injury Prevention ($183M)
•Existence and mechanism
of non-impact, blastinduced mTBI?
•Drugs to prevent and treat
blast-related hearing loss
•Analysis of combat injuries
and PPE performance
(JTAPIC)
•Multi-effect blast injury
models to improve
protective equipment
•Resilience enhancement
and prevention of PTSD

Acute Treatment ($437M)
•Diagnostics and neuroprotectant
drugs for TBI
•Hemorrhage control & blood products
•Treatment of psychological trauma
•Damage control orthopedics
•Pain management

Hair Cell
Antioxidan
t Defenses

CFD Simulation
Observed
Blast LoadingTest Conditions Pathology

FEM Simulation

Reset ($141M)
•Tissue engineering and prosthetics
•Return-to-duty Standards
•Recovery of function

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Before

UNCLASSIFIED

After
Slide 14 of 48

DoD Blast Injury Research Extends
Back to World War II
Nuclear &
conventional explosions
Los Alamos & Albuquerque

Cave blasts
Armored Med Res Lab
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 15 of 48

New Science and Technology Options:
Modernization of Military Medical R&D
Prevention
(Mitigate Risk)

Acute Treatment
(Mitigate Injury)

Reset
(Mitigate Disability)

Systems Biology Methods
Personalized Medicine
Diagnostics
Regenerative Medicine
“Laying the tracks for the train”
Advanced Training Technologies & Neuroplasticity
Individual Resilience
Provider Training
Individual Retraining

Computational Bioengineering, Biomaterials & Nanotechnologies
Biomedical Standards
Wound Care
Advanced Prosthetics
Electronic Health Record Outcomes Research
Injury Surveillance

Optimized Interventions

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Return-to-Duty
Standards
Slide 16 of 48

Chemical Biological Defense Program
Threat Focus
• Advanced Threats
– pathogens engineered to increase resistance, transmissibility,
and virulence

• Traditional Threats
– intracellular bacterial pathogens (e.g., plague)
– viral hemorrhagic fevers (e.g., ebola)

• Enhanced Threats
– “bioprospecting” of virulent strains in nature
– cultivating virulent strains in the laboratory
• Emerging Threats
– natural diseases (e.g., pandemic flu, malaria)
– multidrug and vaccine resistant pathogens
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 17 of 48

Chemical Biological Defense Program:
Transformational Medical
Technologies Initiative
• Develop broad-spectrum countermeasures and novel
technology platforms (one drug, many bugs)
• Pursue countermeasures targeting common disease
pathways or enhance the host’s immune system
• Integrate best efforts within government, academia,
DoD, biotech industry, and small and large
pharmaceutical corporations
• Provide seamless “end-to-end” product development
• Eliminate capability gaps by adding promising
candidate technologies to the pipeline

www.tmti-cbdefense.org; ww.fedbizops.gov
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 18 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 19 of 48

The Changing Operational Environment
“Low level Persistent Conflict”
General Casey, 14 Aug 07

Stability Operations
& International Health

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 20 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 21 of 48

Medical Research and Related Programs
in the DoD
Services

ARO
ONR

AFOSR

DCoE for PH and TBI
DCoE for Vision

USAMRMC

NMRC
ONR

DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)
SOCOM (BISC)
VA-DoD sharing
(e.g., JIF)

AFRL

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Other Agencies

AFMOA
UNCLASSIFIED

NIH joint efforts
Slide 22 of 48

Armed Services Biomedical Research
Evaluation & Management
The ASBREM Committee shall:
• Review medical RDT&E program plans and
accomplishments for quality, relevance, and
responsiveness to military operational needs, the needs
of the Military Health System, and the goals of Force
Health Protection
• Review program plans and budgets in support of the
various guidance documents relevant to National
Security and to the missions and functions of the
Department of Defense
• Provide coordination, recommendations, and support to
DoD Executive Agencies and other DoD officials as
requested, directed, or otherwise appropriate
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 23 of 48

Medical Research and Related
Programs in the DoD
ASBREM
Joint Technical Coordinating Groups
1
2
3
4
5
6
7
8

Med Training Systems & Information Tech
Military Infectious Diseases
Chemical Defense
Biological Defense
Military Operational Medicine
Combat Casualty Care
Radiation Effects
Clinical and Rehabilitative Medicine
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 24 of 48

Defense Health Program: GDF Enhancement
MISSION DESCRIPTION AND BUDGET ITEM JUSTIFICATION: This Program
Element (PE) funds Advanced Component Development of medical products
that are regulated by the U.S. Food and Drug Administration (FDA) and the
accelerated transition of FDA licensed and unregulated products and medical
practice guidelines to the military operational user through clinical and field
validation studies. Projects in this PE are designed to address areas of
interest to the Secretary of Defense and to close medical capability gaps
associated with the Joint Force Health Protection Concept of Operations
(JFHP CONOPS) and are complementary to research conducted by the Army,
Navy and Air Force in analogous PEs. Projects include Trials for Accelerated
Transition of Modeling and Simulation Technology for Medical
Training/Education/Treatment; Trials for Accelerated Transition of Medical
Technology, Practice Guidelines and Standards; Medical Products –
Advanced Component Development; and Medical Information Technology
Development.

$198 M
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 25 of 48

Congressional Special Interest (CSI)
RDA Programs
About 50% of USAMRMC Funding Each Year Is Congressionally Directed
Function of Congressional Special Interest (CSI)
Research:
• Sponsor good science using Congressional
appropriations that are not in the President’s budget Advanced Development 9%
• Responsive to the intent of Congress, managed to
Core R&T 33%
maximize military relevance
Process:
Core
• Proposals peer reviewed for scientific merit prior to
Effort
award
39%
• Programs executed by extramural awardees and
USAMRMC laboratories and acquisition offices
Program Managers:
• USAMRMC Research Area Directorates (33%)
• U.S. Army Medical Materiel Development Activity
(USAMMDA – 9%)
• Congressionally Directed Medical Research Programs
TATRC 29%
CDMRP 32%
• Telemedicine and Advanced Technology Research
Center
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 26 of 48

Medical Advanced Development

Supporting Commands
USAMMDA

USAMMA

U.S. Army Medical
Materiel Development
Activity

U.S. Army Medical
Materiel Agency
Defense Medical Logistics Center

Pharmaceutical
Systems

Applied Medical
Systems

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Integrated Clinical
Systems

UNCLASSIFIED

Medical Devices

Slide 27 of 48

Core Medical R&T
Supporting Laboratories
USAARL

USAISR

U.S. Army Aeromedical
Research Laboratory

U.S. Army Institute of
Surgical Research

USARIEM
U.S. Army Research Institute
of Environmental Medicine
Combat
Casualty
Care
18.3%

Military
Operational
Medicine
17.1%
Medical
Biological
Defense
25.5%

Military
Infectious
Diseases
23.6%

Medical
Chemical
Defense
15.5%

USAMRIID
U.S. Army Medical
Research Institute of
Infectious Diseases

USAMRICD
U.S. Army Medical Research Unit - Nairobi, Kenya
Armed Forces Res Inst of Med Sci, Bangkok, Thailand
US Army Medical Research Unit, Heidelberg, Germany

US Army Dental and Trauma Research Detachment
US Army Medical Research Detachment

WRAIR
Walter Reed Army
Institute of
Research

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

U.S. Army Medical
Research Institute of
Chemical Defense
US Army Center for Env Health Med

Slide 28 of 48

http://cdmrp.army.mil/

FY09 Funding Opportunities:

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 29 of 48

http://cdmrp.army.mil/

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 30 of 48

Medical Research and Related
Funding Programs in the DoD
Services

ARO

DCoE for PH and TBI
DCoE for Vision

USAMRMC

Other Agencies
DARPA
(e.g., DSO)
CBDP/DTRA
(e.g., TMTI)

NMRC
Small
Business
Innovative
Research
SOCOM
(BISC)
ONR
ONR
Small Business Technology
Transfer
VA-DoD sharing
(e.g., JIF)
(SBIR/STTR)
AFRL
AFOSR
http://www.acq.osd.mil/osbp/sbir/
NIH joint efforts
AFMOA
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 31 of 48

KEY TATRC Initiatives and Portfolios
• Cell phone-based systems
• Remote biomonitoring
• Global Biosurveillance
• Health information portal
unified EHR
• Research data cube/
medical outcomes
• Pharmacovigilance
• Virtual environments
• Computational models
& tools
• Human/soldier phenome
• Performance & injury
prediction models

e-HEALTH

• Robotic rescue & evacuation
• Shelf stable diagnostics & vaccines
• Blood products & blood safety

MEDICINE IN
AUSTERE
ENVIRONMENTS

HOSPITAL
OF THE
FUTURE

DIGITAL
WARRIOR

INTEGRATIVE
MEDICINE

• Operating room of the
future
• Prosthetics and human
performance
• Regenerative medicine
& biomaterials

• Optimal healing environments
• Advanced pain management
• Complementary and alternative
medicine
• Neuroplasticity/resilience
• Genomics/personalized medicine

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

• Natural orifice
transluminal endoscopic
surgery
• Advanced medical
imaging
• Distance medical training
& simulation

UNCLASSIFIED

Slide 32 of 48

TATRC Portfolios
Joint Technical Coordinating Group
1. Medical Information & Training Technologies
4. Infectious Diseases

Human
Performance
Optimization

Psych Health
Dr. Shore

Dr. Cardin

Resilience &
Retraining
MAJ
Brininger

Simulation
& Training
Technology

International
Health

Medical
Imaging
Technologies

Health
Information
Technologies

Ms. Stanley

Ms. Barrigan

Dr. Pacifico

LCDR Steffensen

Medical
Logistics

Blood Products
& Safety

Dr. Carney

Mr. DePasquale

Mr. Malloy

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Bio-Monitoring
Technologies

Medical
Robotics

Advanced
Prosthetics

Dr. Lai

Dr. Gilbert

Mr. Turner

Mr. Wiehagen

Genomics
/ Proteomics

Infectious
Disease

5. Military Operational Medicine
6. Combat Casualty Care
8. Clinical & Rehabilitative Medicine

Trauma
Dr. Broderick

Computational
Biology

Nano-Medicine
&
Biomaterials

Regenerative
Medicine

Dr. Reifman

Dr. Grundfest

Dr. Lai

Head
& Spinal Cord
Injury
Dr. Curley

UNCLASSIFIED

Vision

Acoustic
Trauma

Mr. Read
Dr. Holtel

Slide 33 of 48
Slide 33 of 12

Hawaii Federal Health Care Network
(AKAMAI II) – FY10 Competitive RFP
AKAMAI II supports applied research, development and
deployment of telehealth and healthcare technology,
biotechnology, clinical informatics, VA/DoD systems
interoperability, to improve access and the quality of care to
service members, their families, and impacted communities.
With a focus on programs that align closely with military
medical requirements, a competitive process will be used to
provide funding in Hawaii to develop advanced medical
technologies and biotechnology research critical to our nation's
military medicine and the warfighter. Priority will be given to
innovative collaborations between Hawaii-based industries and
the Department of Defense. Outside partnerships that help to
bring unique expertise to research in Hawaii to solve military
medical problems will also be an important factor.

http://inouye.senate.gov/Congressional_Initiatives/
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 34 of 48

Basic Steps to Innovation in the
Hawaii Federal Health Care Network
1. Come up with a concept that would be
immensely important to the DoD, if successful
2. Secure the intellectual property

3. Publish the seminal supporting article in peer
reviewed literature
4. Conduct the initial risk mitigation studies (e.g.,
toxicity) that will encourage investors

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 35 of 48

Hawaii Biomedical Research Advantages
and Dual Use Applications for DoD
• Stable population (~1.2M)
• Unique healthcare system and DoD-VA sharing of
facilities (great starting point to optimize practices)
• Distributed across islands (e.g., model of remote
health care access)

• Chronic health care concerns, even though a state
with the best longevity (e.g., preventive medicine
interventions and personalized health care/personal
empowerment opportunities)
• Modest size makes manageable testbed and model
system and increases cooperation in the islands
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 36 of 48

AAMTI: Pediatric Telecardiology Referrals
with Echocardiographic Validation

AMEDD ADVANCED MEDICAL TECHNOLOGY INITIATIVE
Pacific Rim Pediatric
Heartsounds Trial:
Store and Forward
telcardiology with
echocardiographic
validation

Pediatric Multi-site
Phonocardiography:
Automated
interpretation of
pediatric heartsounds

Simultaneous
Multi-site
Phonocardiography: A
simplified heartsound

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

Improved heartsound
signal analysis using
simultaneous
multi-site
phonocardiograms in
children

UNCLASSIFIED

Telecardiology
evaluation of
newborns with heart
murmurs using
simultaneous,
multi-site
phonocardiography

Slide 37 of 48

Janus – DoD and VA Common Data View

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 38 of 48

Pacific Asynchronous Tele-Health (PATH)
Teleconsultation

Telehealth Services
-VA Pacific Islands
Health Care System
(VAPICS)

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 39 of 48

ICU Multipoint
Military Pacific
Consultation Using
Telehealth
(IMMPACT)

Telehealth Voice
Therapy in Remote
Regions in the Pacific
Basin

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 40 of 48

Environmental Medical Surveillance
(CBI “wet ware” / “canary”)

Cell Matrix Chips for
Air/Water Monitoring of
Toxic Chemicals
Principal Investigator:
Kevin Chinn, PhD; Cellular
Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 41 of 48

Cell-based Treatments
Treatment of Peripheral Vascular Disease by
Adipose Derived Stromal Cell Injection

Development of Technologies for
Bioengineered Tissue Repair

Principal Investigator: Paul Kosnik PhD;
Tissue Genesis, INC.

Principal Investigator: Mark Mugiishi, MD;
Cellular Bioengineering, Inc.

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 42 of 48

Nanotechnology Capabilities
RAIDER: Rapid Adverse Identifier for Drugs and Evaluation
Resource
Principal Investigator: Joanne S.M. Ebesu, Ph.D.; Oceanit

SEM image of nanoarray functionalized with antibodies

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 43 of 48

Development of the versaHSDI
system – Colon
• Automated disease detection
• Video reconstructed colon model
• Local 3D rendering

3-D rendering software
development to enable and
develop Computer Aided
Diagnosis and in situ
pathology for colon cancer
detection
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 44 of 48

Neurophysiologically-based Performance
Monitoring and Enhancement Devices
Intelligent PTSD Classification
and Treatment-Augmentation
Technology
The device will utilize off the shelf
technology and Archinoetics developed
hardware to produce an integrated,
unobtrusive monitoring/communication
capability.

Warfighter Physiologic
System Interface Research
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 45 of 48

Broadband Respiratory Virus
Surveillance

COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 46 of 48

SimCenter Hawaii Technology
Enabled Learning
and Intervention Systems

Virtual Reality Applications for
Health Care Education and
Training
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 47 of 48

TATRC Science & Engineering
Research Support

Dr. Stan Saiki, Chief, TATRC Hui
Dr. Chuck Peterson, Chief Scientist
Ms. Jessica Kenyon, Chief, TATRC West

Mr. Ron Marchessault, ORTA

www.tatrc.org
COL Karl Friedl/MCMR-TT (301-619-7967) (DSN 343)
[email protected]

UNCLASSIFIED

Slide 48 of 48

Hawaii Biotechnology Research: Interest Areas and Opportunities with the Department of Defense COL Karl Friedl, PhD Telemedicine & Advanced Technology Research Center US Army Medical.

Transcript Hawaii Biotechnology Research: Interest Areas and Opportunities with the Department of Defense COL Karl Friedl, PhD Telemedicine & Advanced Technology Research Center US Army Medical.

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