Tripler Army Medical Center (Tripler) is one of the largest military medical treatment facilities in the Pacific region. Located in central Oahu, in the state of Hawaii, Tripler also manages the Warrior Ohana Medical Facility, located in Kapolei, Hawaii and the Warrior Transition Battalion on Schofield Barracks, Hawaii.
Nearly 400,000 people in the Pacific region are eligible to receive care at Tripler, Regional Health Command-Pacific’s premier teaching medical center. This includes Active-Duty service members from all branches of service, their eligible families, military-eligible retirees and their families, veterans and eligible residents of the surrounding Pacific islands.
Tripler’s service region includes Hawaii, Japan, Korea, Johnston Atoll, Guam, American Samoa and various Pacific Island nations.
Tripler has been healing heroes since before the attack on Pearl Harbor. The origins of Tripler date back to 1907 when several wooden structures at Fort Shafter were used as a hospital. In 1920, the facility was named after Brig. Gen. Charles Stuart Tripler, in honor of his contributions to Army Medicine during the Civil War. At the start of World War II, it was quickly realized that the current hospital was too small, so plans for a new Tripler hospital atop Moanalua ridge were drawn in 1942. Construction was completed in 1948.
Each day Tripler provides 1,970 clinic visits, conducts 3,350 lab procedures, fills 1,800 prescriptions, conducts 565 radiology procedures, treats 135 emergency room patients, cares for 135 inpatients, performs 26 surgical procedures and conducts nine live births.
Tripler is accredited by the Joint Commission and has a staff of 3,851 military, civilian and contractor personnel that are evaluated to ensure that the medical center continues to provide quality and excellence in medical care.
Additionally, Tripler provides graduate medical education for more than 260 personnel each year in 14 different physician training programs and 11 non-physician graduate programs. This equates to supplying approximately 15 percent of all of the Army’s licensed physicians each year.
Tripler also completes multiple Global Health Engagements (GHE) missions throughout the Pacific each year. GHE’s enhance ready and deployable medical forces by placing Soldiers in more austere environments while meeting medical training requirements. These activities also present opportunities for key medical professionals to deploy in support of their operational unit, thereby further developing relationships in times of peace.
• Simulation Center (one of only four to be accredited by both the Society for Simulation in Healthcare and the American College of Surgeons Accredited Education Institutes.)
• Unique Department of Defense and Veterans Affairs sharing capability
• Foreign Toxicology Drug Testing Laboratory (Processing more than 65 million specimens monthly)
• Tele-health covering five times zones, including the International Date Line
- Virtual Intensive Care Unit capability
- Inter-disciplinary Pain Management Clinic
- Graduate Health Education program – 260 students covering 25 programs
Tripler has multiple public and private partnerships with the Department of Defense (DOD) Veterans Affairs (VA) Medical Center, the University of Hawaii’s John Burns School of Medicine and the University of Hawaii School of Nursing. Tripler provides medical services to the Hawaii Veterans Affairs hospital. Tripler is also one of two teaching centers with civilian residents appointed and funded by the VA. Sixteen physicians are currently enrolled which is the most in the DOD.
Tripler continues to renovate and upgrade medical facilities and capabilities to provide health care to all eligible beneficiaries. Current ongoing projects include:
- Simulation Center
- Progressive Care Unit
- Pediatric Intensive Care Unit
- Intensive Care Unit
Tripler Army Medical Center, also known as TAMC, has been developing and training military medical professionals for more than 65 years through their Graduate Health Education (GHE) program. For decades, Army medicine has worked to train the military healthcare team of the future through its GHE program and TAMC has been a significant part of the Army’s medical training mission.
TAMC, in coordination with its program directors, provide an organized educational program with guidance and supervision of its residents, facilitating their professional and personal development while ensuring safe and appropriate patient care.
TAMC began the GHE program in February of 1949 when the Internal Medicine residency program received its initial accreditation. The goal of the GHE program at TAMC is to educate and train physicians in various medical and surgical disciplines so that, upon completion of the training program, residents are able to pass their board certification exam, have demonstrated sufficient competence to enter practice without direct supervision, are competent practitioners and are able to practice their specialty in the U.S. and abroad.
TAMC is a major teaching hospital which currently sponsors 240 resident positions in 14 accredited physician training programs including Radiology, Family Medicine, Internal Medicine, Obstetrics and Gynecology and General Surgery, as well as 11 non-physician graduate programs.
“Our beneficiaries deserve nothing but the best,” said Col. Kent Dezee, chief of the TAMC Directorate of Health Education and Training. “By closely supervising our residents, we ensure great patient care for our current patients and excellent preparation for our residents’ future patients. We design the training to meet not only civilian accreditation rules, such as Accreditation Council of Graduate Medical Council and American Board of Medical Specialties, but also the specialized needs of military physicians.”
A potential candidate must be selected competitively by the GHE selection board. These selections are made annually and are based on a number of criteria such as previous schooling, letters of recommendation, Officer Evaluation Reports, titles of completed research and presentations, and board examination scores as well as a formal interview with one of the program directors. All of this information will be compiled to determine where on the Order of Merit List the candidate will fall.
TAMC is affiliated with the Uniformed Services University of the Health Sciences as a teaching hospital and a majority of the candidates have received a health professions scholarship for their training.
“Tripler has enjoyed a robust program of faculty development opportunities in collaboration with the USUHS,” remarked DeZee. “The collaboration provides the trainees medical education platforms, including strong clerkship opportunities, coupled with the highest quality of education; ensuring that our beneficiaries receive highly reliable care at Tripler and throughout Army Medicine facilities.”
The GHE program constantly develops and strengthens the curriculum offered in the program in order to prepare graduates for the evolving needs of patients and the healthcare system.
“The medical field is constantly evolving,” said Dezee “We have to adjust our curriculum to ensure that we are teaching the most up-to-date methods of care for our patients.”
A resident in the GHE program can spend one to six years in the program depending on the specialty of their training.
“The TAMC GHE program did a tremendous job of preparing me for both inpatient and outpatient medicine as a doctor of Internal Medicine and as an Army provider,” said Maj. Eric Swanson, Chief of the Internal Medicine clinic. “We did many rotations during my three-year training at TAMC that included outpatient encounters, subspecialty rotations (Oncology, Gastro Intestinal Tract, etc.), and many inpatient rotations for general medicine and critical care patients.”
The GHE programs also encourage research and innovation to advance patient care with state-of-the-art technology. TAMC is able to produce exceptional educational outcomes with customized training to ensure graduates are well prepared to care for the population of healthcare beneficiaries they serve.
Each year the program graduates approximately 140 residents. This equates to producing more than 15 percent of the Army’s licensed physicians each year. Many of these residents will move on to operational assignments throughout the world where they will begin utilizing the skills they have learned. These physicians are trained on the most up-to-date methods and with state of the art equipment.
“I have done multiple global health engagements throughout my residency program and it has prepared me for just about anything I may encounter,” said Anthony Tolisano, chief resident of the TAMC Ear, Nose and Throat clinic. “Many times on these engagements, we may not have all of the best tools or facilities to operate in and that is what it can be like when we deploy, so Ifeel that once I leave here, I will be ready to perform my best under whatever circumstance I may find myself in.”
Beneficiaries deserve the very best care possible and the GHE program allows them to receive that care from a network of multiple providers working collaboratively with the best interest of the beneficiary in mind.Tripler Army Medical Center Remains at Forefront of Technological Advancements
By William F. Sallette
Tripler Public Affairs
Technological advancements have improved health care for years and the military’s simulation (SIM) centers have strived to be at the forefront of that advancement.
That is why Tripler Army Medical Center (TAMC) recently received an upgrade to its SIM center by moving into a new facility. The move quadrupled the workable space for the SIMcenter and provided the opportunity to train more staff members. It even allowed the center to obtain new equipment they did not have the space for prior to the move.
“We are very excited about the new space,” said Phil Benson, TAMC Medical Simulation Specialist. “The center is now capable of hosting multiple groups at once, which would never have been possible in the old space.”
The goal of the SIM center is to support continuing medical education and graduate medical education (CME/GME), as well as nursing and operational medic simulation training at TAMC. The center provides all staff members the opportunity to train and hone their skills in order to improve patient safety, practitioner efficiency and competency in the clinic, hospital and operational environment.
“It’s extremely fulfilling knowing the support and training we provide to the staff has a meaningful impact on Soldiers and their families,” said Benson.
Although TAMC’s SIM center is not the first in the Army, it is the only center to support nearly 4,000 staff members who are responsible for more than 260,000 beneficiaries throughout the Pacific. TAMC staff members can improve their skills by practicing nearly any situation they may encounter including live births, epidural administration, cardiopulmonary resuscitation and laparoscopic surgery.
The TAMC SIM center has also been accredited by the Society for Simulation in Healthcare, American Society of Anesthesiologists and is one of only 50 medical facilities to receive accreditation from the American College of Surgeons.
These accreditations allow the TAMC SIM center to certify and train in multiple disciplines in the Pacific region as well as give TAMC credibility among the medical community.
The old saying goes ‘practice makes perfect,’ and that is exactly what the SIM center is trying to do.
Whether it is a resident practicing for their simulation certification or a seasoned surgeon practicing a procedure they have not performed in a while, the SIM center provides opportunities for all staff to fully prepare themselves to provide the best care to TAMC beneficiaries.TAMC Shows Hawaii New Imaging Capabilities
By William F. Sallette
Tripler Public Affairs
Tripler Army Medical Center prides itself on being at the forefront of medicine and it recently accomplished a task that no other hospital in the state has been able to accomplish.
According to the Parkinson’s disease Foundation, more than 60,000 people are diagnosed with Parkinson’s disease each year and a Dopamine Transporter Scan is a helpful tool to properly diagnose the disease in its early stages.
A positive scan implies a parkinsonian condition, of which Parkinson’s disease is the most likely one.
In this context, the scan is particularly useful when symptoms are clinically ambiguous and differentiation from other tremor (shaking) conditions such as essential tremor (ET) proves to be clinically difficult.
This type of scan uses an injection of Iodine-123 Ioflupane, a special type of neuro-imaging radiopharmaceutical drug that allows the scan to see the amount of working dopamine transporters in the brain.
The fewer active dopamine transporters, the more likely the patient has a Parkinsonian condition, including Parkinson’s disease.
The challenge with this drug is that it has a very short shelf life.
From the time it is produced at a lab in Schenectady, New York, the drug will only be good until 1 p.m. Hawaii time. This has previously prevented any hospital in the state from being able to conduct the scan.
However, when Dr. Amitabh Gupta was hired last November to establish and direct a movement disorders program for TAMC neurology, the need for DaTscan technology became very pertinent.
With this new requirement, Lt. Col. Yang En Kao thought that with the proper coordination and planning, TAMC could manage to pull off this seemingly impossible task.
Nearly six months ago, Kao contacted the producer of the drug and began coordinating for proper training on the shipping, handling and administration of the drug.
“It took many months of coordination and training between multiple departments of the hospital before we were even able to give the go ahead to ship the materials,” said Kao. “Representatives from the drug producer came out to assist in the preparation and training of the pharmacy personnel for receiving and control and the technicians on the proper use of the materials in the scan itself.”
After much planning and coordination, Kao decided it was time to test their plan and on April 14th Kao performed the first successful DaTscan in the state of Hawaii.
“The test was successful and we confirmed that the first patient we scanned does not have Parkinson’s,” said Kao. “Treatment for Parkinson’s disease and essential tremor is completely different, so it was very important to find out for sure that this patient did not have Parkinson’s disease. This allows us to move to the correct treatment process and improve the health for the patient immediately.”
Prior to this new availability, doctors would have to do their best to carefully evaluate the patient and treat the symptoms based on their knowledge of the diseases.
“Without DaTscan, we would have to rely on clinical monitoring and see if more symptoms, compatible with the diagnosis, eventually would develop,” said Gupta. “A DaTscan is particularly helpful in challenging cases, so in these cases, without DaTscans, only time would tell and we would be limited as to what to suggest to a patient in terms of long-term career and health planning.”
Since the inception of the movement disorders program a few months ago, seven patients from TAMC were deemed appropriate to greatly benefit from the DaTscan, as they presented with symptoms that could be indicating very early Parkinson’s disease. This number will persistently grow each year as more patients are recruited to the Movement Disorders Program at TAMC.
“For those patients who will be receiving this new imaging at TAMC, it has been a profoundly positive impact,” said Gupta. “As the DaTscan is a diagnostic tool for early detection, it is particularly helpful for timely preparation and long-term planning of career and health objectives in individuals with a challenging clinical picture. It allows us to make early decisions about a patient’s life, in terms of career and health, which allows accurate and timely preparation for the patient and family as to what is to come - either way.”
Now that Kao has proved that, through coordination and planning, a DaTscan can be successfully completed here in Hawaii; civilian hospitals in the area are now beginning to look at their own processes to see if it can be accomplished at their facilities.