Fifty miles northeast of San Francisco, and seven miles east of Fairfield, in northern California, sits Travis Air Force Base. It leads the country in the amount of passenger and cargo traffic compared with any other military air terminal. It is home to several units in addition to the 60th Air Mobility Wing. It is also home to the David Grant USAF Medical Center. The facility, operated by the 60th Medical Group, sees 400,000 patients annually.
“David Grant Medical Center (DGMC) is the Air Force Medical Service’s flagship medical treatment facility in the United States,” says U.S. Air Force Senior Master Sgt. Bruce Haskin, 60th Medical Support Squadron section chief of clinical engineering.
The HTM professionals managing the medical equipment at Travis are part of the Medical Equipment Repair Center (MERC).
Leadership in the MERC includes Paula Binns, chief of clinical engineering; Kevin Hoellein, CBET, chief of the Medical Equipment Repair Center; Master Sgt. Aubrey Durkin, NCO in charge, Medical Equipment Repair Center; and Haskin.
The MERC also includes 31 technicians, who service an inventory of 10,187 pieces of equipment.
The group has wide-ranging responsibility for multiple facilities.
“At David Grant Medical Center, we service multiple clinics, and have a joint venture with the Veterans Administration where we service equipment items to serve VA patients,” says Haskin. “As a MERC, we support 34 Department of Defense Military Treatment Facilities in eight states in the Western Region of the United States.”
Haskin adds that each site is visited annually for routine maintenance.
“We also support the facilities with technician support for installations of various equipment including PCRI on new radiology equipment before patient use. Additionally, we work hand-in-hand with physicists during initial inspections/acceptances of new radiology equipment,” he says. “MERC technicians also provide quality control oversight for supported bases during annual visits.”
Both service contracts and database management are handled by unique, dedicated entities that are a part of the military biomed infrastructure.
“An in-house contract services department, a subsidiary of medical logistics, oversees annual service contracts and manages one-time repairs and services,” Haskin says.
“All equipment inspections, preventative maintenance, calibrations, other services, repairs, and modifications are recorded into the Defense Medical Logistics Standard Support database system,” Haskin adds.
Haskin says this includes documenting the amount of time the technician(s) spent on the equipment, and the specific services done to the equipment. The system provides historical information, cost of services (including contract costs), historical cost, life expectancy, maintenance timelines and other pertinent data to determine when the equipment should be replaced.
Training is also unique to the military. Active duty HTM professionals are trained through the same school that many current civilian biomeds graduated from.
“Active duty technicians are trained through the DoD Biomedical Equipment Maintenance program at the Medical Education and Training Campus (METC) at Fort Sam Houston, in San Antonio, Texas,” says Haskin.
“Additionally, before deployment, technicians attend DoD advanced courses including the Advanced Field Medical Systems course, and a manufacturer CT school to prepare them for down-range support of a field CT system with little to no outside support,” he adds.
Part of the reason the team is well trained is that METC training is so comprehensive. Haskin points out that team members may have also taken some advanced courses through the DoD school.
Wide-Ranging Unique Customers
The MERC team at Travis Air Force Base, California, has a worldwide reach. They have also loaned personnel to important humanitarian missions.
“This facility has a high operations tempo for deployments throughout the world,” says Haskin. “Our technicians have served in many countries in Europe, Africa and the Middle East.”
“Two members of the DGMC team were recently ‘deployed’ to San Antonio, Texas, to support humanitarian relief efforts after multiple hurricanes struck the United States and nearby countries,” says Haskin.
“Tech. Sgt. Ryan Schaffer and Senior Airman Nathan Howard inspected and reconstituted $4 million of equipment and supplies to redeploy equipment.”
“They made a couple of outstanding accomplishments during their time. They serviced 367 equipment items and restored 29 aircraft pallets of equipment and supplies. This directly impacted operations and led to the evacuation of 211 patients,” he says.
“They also helped establish a loaner repair and return center to support other installations’ medical equipment needs, which will allow customers to request loaner equipment and have it shipped at a moment’s notice,” Haskin explains.
One thing that further distinguishes the MERC team from its civilian counterparts are the types of services it provides.
Haskin says that the team provides unique services to DoD and VA customers.
“We provide regional support for 32 bases in the Western U.S.,” says Haskins. “This includes some calibration, training and quality control review of anesthesia, audiometers, ventilators, X-ray and acceptance testing of some radiology systems.”
“We perform technology management and life cycle management for all medical equipment used at DGMC. This includes pre-acquisition review and research, standardization, installation, acceptance testing, scheduled maintenance, repairs and disposition,” he adds.
Team members complete approximately 9,500 scheduled work orders a year, approximately 700 acceptance inspections per year and up to 1,500 repairs per year. They also review approximately 600 alerts and recalls per year.
The team has shown that employing some ingenuity can solve some vexing challenges when multiple sign-offs must be tracked.
“One challenge the facility had was a smooth review of new equipment requests with assurance that all of the appropriate parties had reviewed a request before acquisition. Our Technology Management Office revamped all of the associated forms and the entire submission and review process,” Hoellein says. “We established a SharePoint site as a repository for all equipment requests that included tracking mechanisms for the review and acquisition processes. The site was developed to have reviews by specific offices when necessary. They include systems, facility management, medical physics, bioenvironmental engineering, hospital safety and others as required.”
Hoellein says this resulted in better tracking of all packages, expedited reviews and assurance of compliance and special considerations before acquisitions.
“It reduced the overall amount of time from submission to receipt, and it resolved many of the post-acquisition issues and complaints that existed before the new process,” he says.
Another challenge the facility faced was the growing complexity of cardiac cath equipment while still utilizing a legacy PACS system.
Hoellein says the equipment and PACS were integrated poorly, if at all, making workflow and documentation difficult for the providers.
“Technology Management worked with the U.S. Air Force Medical Operations Agency in Ft. Detrick, Maryland, to define requirements, review existing technologies and procure a new cardiology PACS as well as a way forward regarding upgrade paths of additional cardiac equipment,” Hoellein says.
Patients and clinicians at DGMC and many other locations can rest assured knowing that an innovative HTM team has their backs.
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