 Good morning. You guys are ready to go, aren't you? I feel it. Two public-as-service announcements. One, if you haven't grabbed a binder, grab a binder before you go. They're pretty cool. Two, need to identify who you belong to. So, who are my second Air Force Bubbas? Got it? Nineteenth. Got it? AU. Is that better? Okay. Fifty-ninth. Got a couple of you. Okay. And five-o-second. Headquarters. I think we're doing some breakouts at lunch. So get with your respective command chiefs. And then last, but certainly not least. Can I get two claps? And a Rick clap. Where's my reserves? Recruiters. Man, I screwed that up. So hey, I'm Eric Thompson, the Nineteenth Air Force Command Chief. I'm Chuck Brazil from the 59th Medical Wing. And so you're probably wondering, why the heck is the 59th Medical Wing in front of you today? So we own all of medical training for the entire Air Force. That's what we do. So we push through on the officer side, all of your docs, all your nurses, through a graduate medical education, graduate dental education. We also push through all of our enlisted medics through the medical education and training campus. Some of it's consolidated with our sister services. Some of it's just co-located. But we get after it there. Push through about 12,000 enlisted folks per year. And then from the 59th perspective, think about this. We deploy because we are operational as well. We deploy 50% of all AETC deployers every year. It comes from the 59th Medical Wing. And then out of the Air Force Medical Service, we deploy 20% of all medics out of the Air Force Medical Service worldwide. So we own Bagram Air Base. If you go to Craig Joint Medical Theater Hospital, it's pretty much ours. That's what we do every day. And so we're getting after it. We've got a lot of stuff. We have AR, VR, all that cool stuff. Yep, we're doing that in the tech school world. Don't want to talk too much about that. I want to talk a little bit bigger picture. How many of you have heard of TCCC? And I was told I have to use my knife hand. Thanks for that. Tactical combat casualty care. Thank you. Who are my battlefield airmen? You guys already doing this? You are, right? So early 2018, OSD said you will do this across all services. You will train to tactical combat casualty care, TCCC, instead of SABC. But they gave us a phase in to April of 20. So we're working through that now. A lot of you guys already have the programs in place. Some of you do not. We're working on that. The issue is, believe it or not, there's an accreditation piece. So who's monitoring this? Right now we're working through a civilian accrediting body that says, hey, here you go, the National Association of EMTs. Here's our curriculum. This is what you teach. By the way, we're going to charge you $10 per student. $33 per instructor. So there's costs associated with that, right? So who has heard of DHA, Defense Health Agency? They have been tasked, thank you very much. I'm not DHA. Could be. Never know. They have been tasked to come up with a alternative curriculum. And they're working with the NAMT to make that a reality. Of course DHA is kind of busy. Because what are they doing? They are taking over healthcare. And by that, they were tasked in NDAA 17 and then followed up in NDAA 19 with specific language. You will, as the DHA, own all of the benefit. So what do they mean by the benefit? That is your day-to-day healthcare. That's what they've been tasked to do. And they're looking at it from a market-based approach. So who's in the San Antonio area as an example? So if you look at San Antonio, you've got Wilford Hall Medical Center but you also have Brook Army Medical Center. If you're in the National Capital Region, you've got Walter Reed and Bethesda and all that going on. What they're trying to do is capitalize on that to say, okay, where can we best provide your care, not necessarily where do you have to go to based on what your uniform is. Or based on where that specialty is located. So using San Antonio again as an example, all our inpatient care is done at BAMC. So if you need anything inpatient, you can get that done there. If you need a scope, so I turned 50. So what happens when you're a male and you're 250? They said, welcome to 50, right? I went to Wilford Hall for that scope because that's where they have the practice to do that. But then there are other things that we can't do. So how many of you are at a facility or at a base where you do not have obstetrics? You don't deliver babies on base in your medical facility. So we're trying to figure out what makes sense and they're crunching through the numbers and figuring out all of these markets. There's going to be about 11 markets worldwide. Nine in the states and then one in the PAC-AF area and then one in the Europe area. And then we'll go from there. So DHA, it is here and it's going to be here for the foreseeable future. And I'm sure there's going to be questions on that and I expect questions at the end. Because there is a test, by the way. Hopefully you guys are right now, all this down. So did you see a article that came out last week talking about cuts to medical personnel in the military? Did you guys see that? That is a true statement. So the Secretary of Defense, totally separate from the DHA, asked all the surgeons general, how many people do you have as your core? And a lot of us hadn't heard this term core before. Critical operational readiness requirement. Essentially looking at all your O-plans, where are your medics in there? How many are you supposed to have? And so in the Air Force they said, boom, we're supposed to have 25,000. Well, how many medics do you actually have? Well, we got about 30,000. Guess what? Gotta get rid of those other 5,000. And so that's what drill we're going through right now. How is that going to impact you? Well, you take the DHA consolidation, looking at it from a market-based approach. Then you take it from no kidding, the SECDF saying, we're going to cut your medics. We have to look at a lot of things. So we have to say, where can we best provide care? Where can we best push you to the network? And as a little trivia here, what percentage of medical care you think we get on the network? Any guesses? Exactly right. 60% of your medical care is actually done on the network. It's not done in a military MTF. And that number has continued to grow. And the cost of health care has continued to grow. Because health care is about 8% of what we pay out of our defense budget right now. It's projected to go up to about 15% over the next decade with things going the way they're going. So we have to change, right? Because I got to get you with Battlefield Airmen. I got to give you the tools out there in the field to do what you need to do. So, they're looking at this right now. They actually have, today's the 7th, they have until the 15th of March to provide the surgeon general with no kidding, a draft. This is how we're doing the cutting. So how are they tackling it on the officer side? They are looking at it through their consultants. So I've got a medical core consultant, a biomedical core consultant, all the way down to specific specialties to say this is how many we have. These are how many are core, that critical operational readiness requirement. These are how many are over. And then figuring out where are those bodies? Where are those positions? And where are we going to cut them? And it is not an easy process right now. On the enlisted side, they're doing the same thing through the CFMs. Where are they? How are we going to do this? So they're going to come up with a draft plan. It's going to go to the SG. It's going to go to what they call the Air Force Medical Service Council. They will review that and say yay or nay, makes sense, or it doesn't make sense. And I'll give you an example. So for those of you in San Antonio, exceptional care. That's where our only DOD level one trauma center. So if I got a ER doc or a surgeon, trauma surgeon, who I need to send down to the battlefield, where is he going to get that currency, that training? It's going to be there. It's not going to be at the clinic in advance. And so we're going to have to look at how we address care in facilities like that. So looking toward the future, you could see a Army Troop Medical Clinic kind of model in some of our small places thinking about that. And so how does that impact your airmen? How does that impact your dependents? Where do we get our care? And so we're trying to look at that to make sure we get that right. Finally, from there, we're looking at swinging it back around to the education piece who's heard of CCAF? A couple of you, right? So Chief Simmons, my best friend, he runs CCAF for AAU. And they just went through a good talk this morning. He's going to give you some background on that. From the medical side, you're in 1A. 1A, 1A, got it. So CCAF, we are moving away from the medical side to College of Allied Health Sciences. And that's part of Uniform Services University for accreditation. Why? Because we have a lot of specialties that in the civilian side that they get their registries or their certifications can't get those unless they're working to a bachelor's degree level. And so we can't get there right now with Community College of the Air Force. So we're going through that, through the College of Allied Health Sciences. That's going to phase in over the next five years, give or take, depends on which AFSC you're looking at. That said, there is a lot going on, whether it's training, readiness, health care. Questions? Here's where it gets interesting. Hi, Chief. Chuck Loftus. I'm over on the headquarters ATC staff. One of the concerns that I always run across when I'm out on the basis is access to care, not only for the military member and the distance that they sometimes have to travel, and also their family members or specialty clinics. Does this whole DHA process kind of help try to resolve some of that possibly? I mean, with your forecast? Yes. And so that's what they're focused on is strictly, so from one side is cost, but on the other side is no kidding, access to care, trying to streamline that. As an example, if you live in a certain area of a certain city, you might have care on that side of town that is totally on the opposite end of where your facility is. So try to connect those dots through the network. But then also providing a centralized appointment area that helps you get to that the best meet your needs. So there are markers that DHA has set up for those different specialties, those different lines of efforts to make sure we're hitting those particular marks, trying to get you in as soon as possible. Other questions on that? All right. Thanks for your time.