 Okay, what does TAMC stand for that be on the final exam? That's tripler army medical center And and we have the CEO of that huge installation up on the hill Overlooking you know half of half of Oahu Bill's solace and I want to talk about all the things that happen at tripler with bill We want to know more about tripler than we do. It's not just something you see on your right hand When you're driving to wine eye, it's much more than that and it's iconic and historical You're welcome to the show. Yeah, thanks Jay appreciate you having me. I'm excited to talk to you So you are a doctor and your combat doctor am I right? Yep, but be clear. It's a doctor is a degree, but I do have a doctorate degree, but I'm a physician assistant by training Okay, and you and you've been a combat combat situations. Oh many times Yeah, how is it to be a medic? You know, they they call medic and it touches your heart in every movie and every circumstance What's it like to be in the combat field as a doctor? That's a it's a it's a good question. I didn't know I mean early on when I joined the army right after high school So wasn't really sure what that experience would be like and never thought I would go to combat So my first experience actually was was during Desert Storm. I was a medic during that time I was in 101st Airborne Division. That was my first experience to go there a lot of mixed emotions Going you don't know if you'll be able to perform your job until you actually have to do it but I did realize there was The training that we do and that's why it's so important that the army does its training is that you you would respond and you Will act to the highest level of training you've done And I remember being on the battlefield and taking care of people and conducting my eye even under fire Even nervous even with anxiety that you will perform the way you trained and so that was my first opportunity But obviously later on in my career. I had many more experiences Yeah, and those troopers count on you life and death for sure When you're a medic you carry a weapon But we we do every medic on me unless you were you file as a conscientious objector but more than majority of all the medical forces Medical soldiers in the army carry weapon they We will follow the Geneva Convention still of course, but every soldier carries weapon How do I get to be a medic these days suppose? I'm you know, I'm the kind of person who would like to help others on the battlefield What do I have to do? Can anybody ask for a designator in you know as a medic? You're sure the recruiters obviously are all over the country and other ones are best to answer that question But I didn't know it existed until I went to the recruiter myself But there's there's certain things that they look for to let you become a certain MOS in the army So there's a test you need to take that everyone takes it's called the ASVAP and in that test It's really general medical not medical general knowledge that you learn in high school some science some English and so forth And as long as you score a basic level then you would go into Certain categories of MOS as they know that you could be able to make it there, but by all means You could come in and request to be a medic if you meet the requirements, so they'll enlist you as a medic and it's it's it's a Lot of vacancies we should say because it's the second largest MOS in the army MOS is medical occupational specialty. So the number one meaning the largest is the infantryman Number two is the combat medic. Oh interesting. We care about our troops true So let's talk about tripler for a minute tripler is what a little over a hundred years old now is it created Right after World War one in 1920. I'm guessing I'm thinking And it and then it was you told me before the show that it was built to its current size in 1948 After World War two so it is kind of a reflection of the wars not necessarily during the war but right after the So how big how big how deep how much you know What what does the size and scope of the Bippler Army Medical Center facility? Yeah, it transitioned over the years obviously I did some reading on it myself when I before I came here to take Command of the hospital and you're right during the wars is what's what sparked the interest and what I had saw that You know triple hospital. You're right 1920. It was tripler general hospital Which was declared on chapter and it was only like three or four wooden buildings over there at the time and and then after World War two during World War two we had to Have some capability of all the casualties coming back to the island what they initially did is out at Schofield They they built the hospital out there Not too many people know that but it was a big hospital But they realized that all the casualties coming in from the Pacific on the ship We're right over here And the transportation to get them all the way out to Schofield the care for and what was logistically a challenge So a lot of the casualties and then started going to the civilian hospitals, you know within the Closest to the port and they realized at that point. They did they they built trip They started building tripler and they descope the hospital Out at Schofield. So 1948 your ideas when they opened up the the the current pink palace as you see today And the capacity there was was was large What a transition in today, and we could it's the largest Medical center a tertiary medical center in the entire Pacific it supports all of the all of the Military forces in the Pacific there all the little medical treatment facilities out there what we'll use us as a referral hospital And it takes care of every medical. I mean every military Service that's here in a while. So not just army even though we're an army center. We take care of all services here Including the retiree of the veterans administration and all that Yeah, so so what we call our beneficiaries those we who we care for number one is our active duty population So every service of our active duty population their family members and then the our Retirees whether that's a 20 year plus retiree or a medical retiree What will be our beneficiary and those in the in the veterans administration only if they're beneficiary for another reason So we have dual status those who are retired from the military or medically retired from the military are also Seen by the veterans administration, but they're also dual beneficiaries of us So it it's a large number of beneficiaries I was I was told once that one fourth of the population of Oahu is a beneficiary of our hospital Wow, I mean what one out of four one out of four Well, it's just going to change as far as the veterans are concerned when they open that new facility for the veterans You know down in wine I somewhere. I don't know exactly where it's in construction right now. Oh, yeah It's definitely needed. I mean obviously our veteran populations is large and getting larger as those who serve here I want to stay here in the island and don't blame them Currently we are combined with the VA veteran administration actually is in one of our wings Administration and then behind our hospital. There is actually an outpatient clinic. That's there obviously at capacity we have more Beneficiary of VA has more benefit beneficiaries to take care of and then also we want to Care for our population to where they live and that's makes a lot of sense for them to Open the clinic out there to be closer to where the veterans live We have our outpatient clinics as well So Desmond Doss health clinic that's out at Schofield barracks You know falls under triple army medical center So we support that population out there and they will also have a warrior Ohana Clinic that's on the other side of the island as well So we try to do the same to be closer to our beneficiaries so Can you give me some stats on how many patients you serve say in a given year how many doctors and staff you have When you when you drive up to tripler in the morning and you look at this enormous structure and you say, ah, it's all mine And I manage all of this. How big is is the force you have to manage? Well, it's actually 4,000 people 4,000 employees, you know half for military half our civilian it is massive It's a huge training facility as well over 28 specialties We don't know we train, you know surgeons internal medicine doctors radiologist. You name it large Training platform a lot of people so I it's the it's the government's hospital United States Army Hospital You know defense outage agencies hospital not not mine I'm just privileged enough to lead the people that are there and it is a blessing to me to come in there every day And and help support people solve problems and making sure that the the patients are cared for What what a great place to work and I'm excited to go there every day Yeah, I would be too. Yeah, it's not like a great job actually I'm not gonna follow your career track that So there's there's one point I would bring about it was really interesting and not not too many people know that but you know You mentioned the the staffing there a lot our civilians and a lot of those civilians are our all our community But those who who serve with the military a lot of people in those civilians can work with the military, but they do But all of them take the oath just like we do so when they're when they're hired into their job And they say they take the job before they start work They they raise their right hand and they they you know swear or affirm that they will support and defend the Constitution in the United States And so they're they're bought in there. They're not just here To to serve the patients that they're serving in front of them. They're they're serving their country They're serving the the military in our way of life We want that bill. We want them to be faithful to the country no matter what Let's take a look at some of the slides that we have some of the pictures we have which is all off your website Looking at the hospital you can describe it. That's an entry way. Is that the main entry? Yeah, that is the main interest It's kind of a way the hospital is built if you could see the design from you know from the sky You can see we're right up against the mountain and so that's how we describe the entrances of our hospital There's two entrances. There's the ocean side as you see the one that faces there as you're looking And there's also the mountain side and that's the back end of it So there was major renovations that was done to you know 1948 is when it was built However, you knew back then we didn't have central air. We didn't have a lot of things So the way the hospital was designed on the mountain Was for the wind to blow over the mountain to blow through all the windows of the hospital The cool the hospital off so since then obviously a lot of construction taking place the the back end of the building was was uh Expanded and so the night I believe is in 1985 is when they did a major renovation Which uh, I mean they did a tremendous job of you know, obviously giving up say see and Creating more clinics floor space operating rooms. It's a really really a huge hospital and and they're really well Constructed Well, it sounds like the federal government has made significant investment in the hospital and and it's here to stay And we talked before the show about the new fit Simmons Uh, I call it new but the old fit Simmons proceeded the new fit Simmons And that's right near Denver and it was a big hospital the same kind of pink palace design as in tripler, but 20 30 years ago, they retired it I guess they weren't, you know, it wasn't the same kind of demand for medical services in that part of the country and they they made it into a the tech center Under the department of commerce, but it is reminiscent of tripler. It's so interesting And and the question I put to you is, you know, is is tripler here to stay forever? You know within a reasonable look into the future I imagine the tripler is going to be around no matter what happens. We'll always have tripler. Am I right? Uh, I would agree with you. It is not going anywhere now. Uh, How we talk about the years we talk about fit Simmons I can tell you tripler is the is the oldest, uh hospital currently in the inventory So so there is plans to to build a new tripler. Uh, it's not they're not in stone yet We still need to decide on the location if it's going to still be here in this complex or somewhere else The size and scope that it's going to be But but they're they're working on a replacement because they're as you I'm sure you know Talking to many people in the community the infrastructure issues on the island and what we're talking about the You know, the water pipes that need to be redone and then the way the the hospital was designed in 1948 really doesn't Set with the standards of how we build hospitals today You know the size of the rooms and the You know the hand washing and amount of sinks and the All of those standards of how to run a hospital with good quality and safety But we really need a new hospital to be able to do that So there are there are plans there triplers here here to stay it will continue to support All of the department of defense throughout the entire pacific a very important Location for us to have a major medical center Now for the now for the doctors, um, you know, I I trust that the doctors can do their residency At tripler you have lots of specialties. You have I would say every specialty, right? And at 28 Okay, it's hot and you have all this equipment. You know including some high tech equipment Um MRI that kind of thing And so you're as well outfitted as any hospital in hawaii, right? Oh, yeah, yeah, definitely compared to and we're also a level two trauma center So on the island queen's hospital is the only level one trauma center by american college of surgeons on the island We're considered a level two And so we see trauma we do all the all the same things a lot of the specialty is just like any other major medical center And the the uh, some of the specialties that we bring here meaning the providers that the army provides Are sometimes even above and beyond anywhere of the civilian hospitals They're particular when it comes to pediatric subspecialties and the neo nato intensive care unit we have It's actually even beyond some of the capabilities that the other hospitals on the island has In reverse they have some things that we don't have as well as one of the hospitals Is a burn unit on on the island where we're not a burn unit We can do the initial resuscitation, but should transfer them over so we share resources I'm in collaboration with every CEO on the island And we collaborate and we're making sure that we're together as one team particularly in National disasters that we need to respond together obviously the covet Pandemic we worked with closely and well together and we do every day Yeah, so we talked to earlier before the show began about the difference between medicine And when we call it combat field medicine Can you describe the difference in terms of concept in terms of practice? Wow, that's a it's a huge huge question there Hopefully I can capture it in a few words if not take up too much of the time But everybody truly understands what what we do in a hospital obviously it's regular It's uh, they've been to the doctor before and some people maybe had surgery It's very structured. You have tons of resources. You have plenty of time You have plenty of light. You have plenty of help Everything is in ideal situation as it can be The battlefield is totally opposite than that You're going to have unlimited resources Not ideal time. It could be at night. You could be on the ground. People could be shooting at you There's totally different environment And so with those different environments We we need to be able to train our soldiers the soldiers are the ones Who need to adapt to those two different environments one you work in the hospital to maintain your medical skills But then to you need to develop all these other skills to do things that That you that you wouldn't even be allowed to do here in the hospital But you need to do on the battlefield in order to save lives Wow, that's that's interesting and exciting. What what was the the the slogan we talked about about keeping Keeping the blood. What's that? Oh, yeah reference Yeah, just one of the the things is to keep the blood in the body, right? So that's you know, we talk about innovation that that's one of uh, you know, the military medicine is one of the great innovators to medicine overall A lot of the things that uh, you know tactics and techniques and new Innovation procedures for in our hospitals today. We learned it during a war You know during all the way from every word look back from washing our hands to Doing a particular surgical procedure developing triage on who we should treat first and Surgical techniques all those things. There's a lot of innovation that comes out of conflict So so the last our last 20 years, you know, we've we've been in combat over in the Middle East So that that keeping blood in the body is you know comes from one of the Things that we relearned is to use a tourniquet We've always always had tourniquets in our inventory back in the other days But they weren't really Efficient tourniquets ones that actually work and also in medical training They used to teach everybody that's your last resort. At first you're supposed to just like put pressure on it Then you should elevate it Then you put a pressure dressing and then the last uh, the last cause you supposed to put a tourniquet on Well, everything, you know, everything's turned on that now We know that the first thing you should do is put a tourniquet on when you have massive bleeding In order to keep the blood in the body as quick as possible The for survival And so all medical training and to include myself when I first came in as a medic In all physician nurses everybody learns what they call the abc's there was airway breathing circulation So when they go and learn cpr they do do bls Everybody was burned in their mind and that's what you're supposed to do Well, the early 2000s when we realized that you know people were dying in the battlefield the same way they died during getty's bird Same way they died during the korean vietnam war is that they were bleeding out But with new technologies we were able to you know do the research and realize that you know We need to stop this bleeding before we worry about their airway So now even in our basic even here on our ems trucks and the hospitals Even in the current red cross training now one of the first things you do is check for massive bleeding before you check the airway So it's a paradigm shift. It changed the way we practice medicine and it was learned from the battlefield Yeah, it's very interesting. So you're training people at tripler What can you describe the training programs you have there? Yeah, so training exactly what we do is it's uh, and we have a different name for a hospital We we call it our health care readiness platform So essentially it's a military term for this is where we we do our training to prepare for war So if we have these lists or tasks they're called individual Critical task lists and these individual critical task lists essentially is the tasks that you should be able to do On the battlefield and every specialty it will have their own lists that they need to perform So some of those can get done inside the hospital just by seeing their regular patient care They're you know surgeons perform surgery. They're getting those tasks done You know medics are are doing evaluations and learning how to take care of the sick and ill Nurses are doing the same so a lot of that's done there But there's a lot on that list that is not done in the hospital Or that the illness or injuries are not there for us to actually do to do So we have two things that we do one we have a large simulation lab That where we have the state-of-the-art You know cameras patient simulators models That that actually talk to you that bleed And then we have all these scenarios that actually we can Mimic as best we can what the casualty will look like on the battlefield So we'd be able to get competent within that skill We also do it outside the hospital where we're doing it more in an austere environment where the medics are on their hands and knees on the ground And they're covering for fire and we're we're putting them in the situation of not just treating the casualty But putting them under stress that hey, we need to move to this new location A bomb just blew up over there somebody shooting at you In order for everybody to understand that this is the environment that you're going to have to do your task in Oh Oh, wow. So, um, it's either sounds like medical school. Are you also exchanging Staff resources with the john abern school of medicine aside from the hospitals themselves Oh, yeah, yeah, so there we do have collaboration on there mainly I know in research our nursing programs are pretty well together We accept residents from from other places not just the military To include the va there as far as a physician. So there they go through our no more programs as well The research is it really and so we we collaborate with the university of hawai as well as the Uniform services medical school and these research Working with the residents as well, especially those in infectious disease Work work on helping us innovate too for the future They they go out to the pacific and a lot of different islands They research on you know, all the things that cause diarrhea, for instance That can be a huge problem to military forces who deploy in the pacific We learned a lot of that before you know during the the real wars and and it's definitely not Has not gone away and we still need to be able to to look at that. So we we call that dnbi and that that stands for disease non-battle injury If if our service members are deployed and get sick Then then they can't fight right so that's what the army medicine is there for is to conserve the fighting strength to get them back into the fight So it's just important to learn medicine and to fight disease as it is to learn trauma skills Well, it strikes me that you have a huge constituency Um, you know probably more than any other medical facility in the state anyway And having a huge Constituency gives you a special advantage in in gathering and analyzing data for research So, uh, I imagine if you have thousands of patients the data on any given disease or conditions It can be very valuable to researchers at Japson or elsewhere And I wonder if you do share that because that could be You know a critical point for modern medical research, no Yep, so that max they're on my calendar I believe tomorrow I think I have a tour over there and we have a meeting where we collaborate Once every quarter we get together and talk. So that's uh, that's definitely what you're describing actually happens So let's talk for a moment about covet You know because covet involved research and getting a handle on exactly what this thing was on an epidemiological basis And I imagine you have treated a lot of covet patients. You may still be treating them What was your role? You know a tripler's role in dealing with covet as it as it existed as it still exists in in hawaii Yeah, obviously taking care of our patients that that was number one We wanted to save save as much lives as possible. So that was uh taking care and I tell you we didn't we didn't do it alone Right. It was a community effort To know what the senses of of all the available beds and providers and nursing nursing staff throughout the entire island That was the that was the easy part I would say is be able everybody just taking care of patients That's what they normally do The really challenge was when it comes to logistics, right because we live on an island You know the supply chain the energy coming from the mainland whether we have the right Supplies medications, you know dressings two beans Oxygen all those different things really had to be looked at and realized and planned for If we had enough we're going to run out and and how do we get all of that? So that was more of a challenge than than actually caring for for patients Testing is where where the military really did some state of the art And again, we weren't just taking care of our population here on the island We're taking care of the entire pacific so major testing facility here that was was able to Not just do the regular testing of kovit, but also the variants that were coming through Tagging those and sharing that data, you know throughout the island our civilian partners to a well of the military Another thing I wanted to discuss with you something we touched on before the show is that is the The the the doctor shortage, you know, josh green Soon to be our governor was on think tech an hour or two ago And I will be talked about it then But i'm sure he's very interested in the doctor shortage He talked about it in the course of his campaign And I wonder how the the doctor shortage affects tripler how has it affected tripler How is it affecting tripler and what are you doing about it? Yeah, thanks. Thanks for the question. Yeah, that's uh, it's a problem throughout our entire country You know not not just here on the island, but also on the on the mainland we we've always had a physician shortage And even greater I would say nowadays is a nursing shortage We we felt that uh very very much during the kovit crisis Even more than the physician shortage is a nursing shortage and the support staff to be able to take care of them I I believe we have it a little harder because of our hiring process or how we bring people Into you know, as I described before we we have military Providers there and we also have civilian providers So there's a HR process that how we get the civilians in and sometimes it's uh, we have to go through different loops And we don't always pay as much as the Is our the competitors might be on the island so we we have a challenge with that To get those providers on we're able to sustain because Our military providers, you know, we we pay them and to be in uniform and We can move them onto the island to kind of help us out to fill those those gaps. So The best way we deal with it is we communicate with our hire We have reached back to To our higher headquarters and to the island and now with uh with our ability with the defense south agency I'm not sure if you're tracking that is the that kind of brings all of our services together So the army navy and air force who will all have medical services What we're all under as far as the medical treatment facilities are all under defense health agency now And because of that we can gain full resources from from all services To be able to fill our our gap in our our challenges that we're having With all capabilities and not not just physicians All that considered bill. What would you say? Your primary challenge or challenges are In managing this very dynamic very important facility a facility that has such huge moment For the military and the state and the pacific What do you worry about it to in the morning? Oh, yeah, I'm worried about change that change is going to happen in the middle of the night So how I get ahead of that? I mean I look uh, I try to look around the corner I try I try to predict it and the way I do that is by communicating I communicate a lot Up and down and left and right. I make sure that You know, I create an environment with the staff that it's free to open up and Say any concerns that they might have because that's what helps me get ahead of a crisis If I know that there's a problem there ahead of time that I can fix that I can resource That I can talk with partners about and that's what helps me get ahead ahead of the game So when I'm when I'm out of the hospital, right? Or if I'm uh, if I'm sleeping Yeah, yeah, that's uh, that's the the the only time where there's a I feel that there might be risk But the more I communicate the more it helps me Look around the corner so I can react to change so change is the biggest challenge Yeah, and you got to stay in touch with it certainly So this you know this this doesn't sound so much like a military billet as a civilian billet that the manager of a huge medical facility And um, you know, you're you're a bird colonel and sound like you're doing the work of a three star That's just me speaking But what's your future career look like? I mean, how long can you stay as as the leader of the commanding officer of tripler? Where does that interplay with retirement? Where does it interplay with some, you know promotion and You know changes permanent station It's a lot of a lot of their impact there. I could tell you the uh, November 2nd that just passed it was was my anniversary coming in the army I just went over 35 years being active duty and I tell you I'm thinking about making it a career. What do you think? It's worthy to tell Yeah, yeah, I'm I'm hoping I'm hoping to make it a career, but I've I've had a tremendous career I spend 10 years enlisted like I said as a medic and a nurse Before I got commissioned as a PA and I spent 25 years actually doing that I have tons of great opportunities and experiences. I traveled around the world I I worked five years at the white house medical unit and Uh met a tremendous amount of people there and a tremendous amount of responsibility I was able to uh, you know command another clinic and Command a special operations unit when I was at Fort Bragg I've done and I'm in a dream assignment here in hawaii leading leading and working with with great people. So Great great career and and I'm going to stay in as long as I'm having fun That was a deal my wife and I had as long as I'm happy what I'm doing I'm giving back to uh to my community and to the military I get to develop others every day and and provide leader development It gives me energy to do that. So as long as I'm doing that as long as I they will keep me I will stay so the the great thing about it is that I you can stay in the army for 30 30 years active federal commission service So the 10 years that I have as a listed doesn't really count against that limit So I really only have 25 years as an officer. So really I could stay another another five years before I have to get out But I'm I'm sticking around to have fun If the army sees it to promote me, I'll I'll gladly, you know, take that and stay in But if not, you know, I'll I'll hand it to the next generation And I'll continue to support the the military and community and in civilian life I want a great career no kidding And I and I want to ask you this too because you know people on the outside. They don't really understand it It's sort of a bifurcated position That you have But I wonder if you could identify some some of the traits some of the The the worldview points that you carry around with you that have made you successful in this You know this complex m.o.s What what do I have to do? What do I have to know what kind of attitude what kind of traits should I cultivate in myself to get your job? Well, that's again a big big question to Jay. It's uh, I didn't know at all. I could I could tell I don't know it all today either But I could tell you I developed as I came up in the army I learned a lot from other people I was you know coached and mentored To get through some tough times That development helped me become the person I am today Uh, and I become I became very humble and realized that the more uh, the more humble I am the more I can learn How I got these positions is really because other people recommended me for them I didn't go out and seek them It kind of just uh, it kind of just happened So, uh, what I would advise other people how to get the job or how to be successful I would say, you know, you know, uh, you know, be positive Um, take care of other people. Uh, be humble Do do well at your job. You know, take care of your boss. Take care of other people Um Do only the things that that make you happy Uh, those that's what gets me through life. So it's it's helped me it's worked for me That's that's that's how I got where I'm at. It's just by being a humble leader and serving others Very gracious. Thank you very much bill bill solace the Commanding officer, I guess is that the right uh, nomenclature? Yeah, a lot of titles now commanding officer director. Um, there's uh, you know, ceo guys, there's a A lot of different jobs that i'm doing they say here your dual had it triple had it. Uh, but but it's fun to work it all out And a nice person. I really enjoyed this conversation with you Thank you so much for sharing all this this incredible wealth of life at tripler. Thank you so much bill And thanks for having me j Thank you so much for watching think tech hawaii If you like what we do, please like us and click the subscribe button on youtube and the follow button on vimeo You can also follow us on facebook instagram and linked in and donate to us at think tech hawaii.com Mahalo