Battlefield Medical Lessons from Ukraine: Adapting to Future Conflict

Description:
In this episode of At the Boundary, GNSI’s Jim Cardoso sits down with Dr. Tracey Pérez Koehlmoos—Director of the Center for Health Services Research and Doctoral Programs in Preventive Medicine & Biostatistics at the Uniformed Services University—to explore how lessons from the Ukraine war are reshaping U.S. battlefield medicine.

From the death of the "Golden Hour" to the rise of drone evacuations and mobile surgical units, this conversation examines how the U.S. military is preparing for medical realities in future conflicts—especially across vast, maritime regions like INDOPACOM.

Topics include:
 • Why traditional evacuation timelines are no longer reliable
 • Medical innovation in low-air-superiority environments
 • Field surgeries, hospital trains, and rapid-deployment surgical ships
 • Challenges of sustaining operating rooms at sea
 • Digitizing battlefield medical records
 • Impacts of aging fighting forces and declining youth health

Follow the GNSI Podcast At the Boundary for weekly conversations on global security, strategy, and defense innovation.

Links from the episode:

• GNSI YouTube page

• Transatlantic Forum on Cybersecurity with GNSI, Paris-Saclay, and the Florida Center for Cybersecurity

• “The Spy and the State: The History of American Intelligence” by Jeff Rogg

At the Boundary from the Global and National Security Institute at the University of South Florida, features global and national security issues we’ve found to be insightful, intriguing, fascinating, maybe controversial, but overall just worth talking about.

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The mission of GNSI is to provide actionable solutions to 21st-century security challenges for decision-makers at the local, state, national and global levels. We hope you enjoy At the Boundary.

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Transcript

Jim Cardoso: 0:00

Jim, hello everyone. Welcome to this week's episode of at the boundary, the podcast from the global and national security Institute at the University of South Florida. I'm Jim Cardoso, Senior Director for genocide, and your host for at the boundary today on the podcast, we're looking forward to speaking with Dr Tracy Perez colmus, she's a USF alumni who's now director at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. Before we talk to Dr Perez ComuS, though, we wanted to remind you that our newest research initiative here at GNSI, the Axis of Resistance, will debut this week on our YouTube channel. GNSI, Research Fellow, Dr Armond mahmoudian, will tee things off with Dr Mohsin Milani, Executive Director of the USF Center for Strategic and diplomatic Studies, Dr Malani is one of the world's foremost authorities on Iran, and his latest book, Iran's rise in rivalry with the US in the Middle East was published recently. This discussion will be the first of a series of panels and interviews that will explore the Axis of Resistance. Be sure to subscribe to our YouTube channel while you're there, so you don't miss any of them. Also this week, registration will open for our upcoming policy dialogs, virtual event Trans Atlantic forum on cybersecurity on June 23 GNSI will partner with researchers and experts from the University of Paris Saclay to discuss areas of national security concern in cyberspace. We'll drop a link for registration in the show notes. Finally, GNSI, Senior Research Fellow, Dr Jeff rogs, newest book, The Spy in the state, was recently cited in an article appearing in the Atlantic. The article is titled, How spying helped erode American trust. The article explain expands on an idea Rob touches on in his book that the business of intelligence, aka spying, is, quote, inherently un American, unquote, and a practice ill suited to a country that values honesty, transparency and forthrightness. It's a good article and an even better book, and you should check them both out. We'll have Jeff on future episodes of the podcast to talk about his book. Okay, it's time to bring on our guest for today's episode, Dr Tracy Perez colmus. She's currently director of the Center for Health Services Research and doctoral programs in preventive medicine and biostatistics. That's the center at the Uniformed Services University of the Health Sciences, commonly referred to as usues in Bethesda, Maryland. She's also a professor at usues, and earned both her Master's and PhD right here at the University of South Florida. We're excited to have her on the podcast today. Tracy, welcome to at the boundary.

Tracey Perez Koehlmoos, PhD, MHA: 3:06

Thank you so much, Jim, it is always a pleasure to get my bull go Bulls on and be amongst my people. Go Bulls. And you know, just a joy that the toolkit that I got doing public health and health administration at USF has been able to carry me into a tremendously meaningful career. So thank you.

Jim Cardoso: 3:27

You started to talk a little bit about your background, obviously, your bulls background, but tell us a little bit more about your background and your current research. Sure.

Tracey Perez Koehlmoos, PhD, MHA: 3:36

So my PhD is in public health. I was an Army officer back in the day, and people often think I was some because I work in health and health care. Now, people often assume that I was something soft, but I was an Air Defense Artillery officer in the Army. I was not soft. My War was the first Golf War, Gulf War. I was an army wife, and that's what I was doing when I was working on my degrees at the University of South Florida, I led big programs in international health across South Asia, before repatriating to the United States when we became a Gold Star Family, and I was working for the Assistant Commandant and Commandant of the Marine Corps in my previous job, before joining and being The sort of seduced to join the Uniformed Services University to stand up a robust portfolio of health services research and take their Dr Ph and convert it to a true PhD in public health to help meet the needs of the Military Health System and the Department of Defense. So I'm a fed. I always think it's important for me to share that with you all that I'm a federal government employee. I will try to be as relaxed and happy as a Fed can be when talking, but we'll see how this goes and we are wrapping up, in addition to a robust portfolio, a sort of more mundane, racial, ethnic disparities, low value. Health Service, utilization and access studies. The work that we're going to talk about today, I think, has more to do with I have a large portfolio of work coming out of the current Russian Ukraine crisis. We were asked early on the invasion. Was February of 2022 2022 Yeah, I was I was asked right at the end of 2022 to design and implement some research that could illuminate what's going on in the health and trauma system of Ukraine. So I am rolled in today, prepared to talk about those things with you. Excellent,

Jim Cardoso: 5:36

and we look forward to it. So before we get deep into Ukraine, let's first discuss, you know, America's most recent major combat experience, which would be G wat, Iraq, Afghanistan, and what would characterize battlefield medical operations during that time, which were unique to that conflict, or at least, which possibly are not representative of future war,

Tracey Perez Koehlmoos, PhD, MHA: 6:03

absolutely. So that was really an asymmetrical conflict. We had air superiority so that we had the unlimited air bridge wherever we went. We could bring people in, we could bring in supplies and equipment. We could exit when we wanted to exit, people were injured, and we developed a norm called the golden hour with the idea, but actually we say golden hour, but it's really more a platinum 10 or 15 minutes, right there at the at the point of injury. But we established, along with our colleagues at NATO, and executed really robust systems of role one, Rule two, role three and roll four and five, being further back and away, far away from from the battlefield for more intense care, but we were able to move the wounded as quickly as we were able as possible, ideally by air, preferably within an hour, getting them to definitive surgical care To help treat their wounds before we would move them to a higher level of care. So we had some really great we had unlimited communications. And so it was really just a great place to sort of execute. And there was a lot of learning that took place. We stood up the joint trauma system, for example, if you've not heard about that previously, that was a great innovation, where, and it still meets, it still meets once a week. It's a virtual meeting, and they would take a case from the battlefield and follow that case through the system, in addition to collecting the data so that real time lessons learned could be translated across the enterprise. It is the Institute of Medicine declared that the joint trauma system that we developed during OEF and OIF was the ideal learning health system that you take and it could be something as simple as, hey, surgeons down range, if you leave an extra inch of skin for a for an amputation, this is the improvement we can make to the outcome for that warrior going forward, and what it does for that warrior for the rest of their life. So they were able to really look at was what was going on, and bring everybody together. And again, the joint trauma system continues. And when COVID broke out, we were able that, not me, some of some of the medical leaders of the Military Health System were able to commandeer, at first, the joint trauma system, or the JTS, but then they developed their own system where they were they brought the same methodology of learning health system to quickly gather information about, you know, burden of disease, challenges and care of individuals with COVID as well as specialty items like what to do with pregnant women, What to do with children with this disease. So it really is a tremendous learning health system, and it came to us through some real innovation, and people who wanted to say, yes, because you were in the military, also, you know that it was very easy for people to say, This is my chain of command, and that's a great idea, but you I don't have the power to change. And so it was visionary leaders like Lieutenant General Doug Rob or, at the time Colonel John Holcomb, really visionary leaders who were able to do some meta leadership and work across different silos to bring the joint trauma system and the data that were collected that way to life during OEF and OIS. So we really it was a real highlight of military medicine over that, that those 20 years of conflict,

Jim Cardoso: 9:52

oh yeah, there's unquestionably some incredible advances that happen across the board. And I mean, in well, not just, I mean, obviously web. Nearing and targeting and how to actually execute military operations, but also the the medical side as well. And I mean, and I think a lot of that would obviously be, you've created lessons learned for the future, but now shifting a bit, we're seeing the future of warfare is, is changing or and in some ways. And we talked about a little bit yesterday, is almost Some of it's going back to the past, almost, and how warfare was fought a century ago, in some ways. And so what are some of the main lessons that you're seeing in Ukraine that are different from G watt and may signal challenges to the US in the future that the US may not be prepared to face?

Tracey Perez Koehlmoos, PhD, MHA: 10:39

I think that we I think just in general, we are preparing to face a lot of the things that they're facing in Ukraine that are very different from from where we were. So I do want to give a shout out to my colleagues at the Uniformed Services University and industrious providers and researchers across the Department of Defense, and our colleagues at all, like the applied physics labs and that sort of thing, that there's a lot of work going into our understanding of the future of warfare, including very from a key point, what we've learned from from Ukraine as well. So some of the lessons that we're seeing from Ukraine is, of course, and I love to say this, and I said this at a meeting, and the Surgeon General of Ukraine walked up to me afterwards and hugged me. Because, for those of you who can't see me, because this is a voice issue, I'm little, like I'm little, and people hug me right during the pandemic, I was quite sure that I would die, because people couldn't stop like seeing me being happy and giving me a big hug. Oh, they're going to kill me. I'm giving them the elbow they're giving you all but the Surgeon General of Ukraine and some of the other leaders of Ukraine, I was at a meeting at NATO last May, and I made you know I was talking about, I lead a syndicate on medical evacuation and repatriation. And one of the things that I said is the golden hour is dead. And I would we would be remiss to talk about the golden hour in the presence of Ukrainian war fighters, leaders and military planners, because that was an idea, that it is an ideal, and we were able to make it work for almost,

Jim Cardoso: 12:22

you know, 2020, 20 years, yeah,

Tracey Perez Koehlmoos, PhD, MHA: 12:24

right, or two decades of war. But in Ukraine, they don't own the skies. They don't own communications, right? It's so they've had to work with what they have. So we see people lingering longer at the point of injury. We hear heroic stories about Ukrainian soldiers being sent forward with a pain pill and a an antibiotic, and if they're injured, they're to take those two things and wait to be saved. And you have stories of soldiers lingering in an injured but controversial, you know, a conflicted geographic zone, and having to stay there, sometimes for days, and perhaps try to low, crawl their way out to safety. And so these are the sorts of things that we were hearing about early on from the Ukrainians that we hear that they don't own there's there's jamming, so then they can't always rely on communication techniques that were known to them. They don't own the skies. They don't have air superiority, so they're unable to use helicopters to move people. So instead some of the innovations that have taken places, they'll talk about drones. And I know when I see you're a pilot, and when I say the word drone, and this is what I thought at first, is that, you know, oh, it was a drone, like, like an airborne helicopter type drone that I would like to deliver a pizza to me, or whatever, or like that they're using to deliver blood in different remote areas of Africa, like in Malawi, but it's not that a drone flies in and picks up by air. It's the drones that go in to pick up the injured, and these are still in the test phase. They're more like a remote controlled car. So when you hear about using drones to remove injured service members from the battlefield in Ukraine. It's not in the air, yeah, it's not there yet. It's remote controlled car. But I think that we have the vision of that, you know, and I've seen prototypes at conferences of the drone that will be able to pick up the injured service member and return them. So we've seen that. We've also seen, and this is the part that really blows the sort of the people who made the rules, the role one, the role two, the role three, hospitals, there's different procedures and services that are available at each of those roles. And what we've seen out of necessity, and you. Crane, we see surgeries and resuscitative services taking place closer to the point of injury, so that we have role two is really like role two plus, and we see that then they're even having to hold the ill and injured the wounded longer in those places than we would ideally like. The other thing, again, with the lack of air superiority, they're moving. Ukraine is a big geographic space. It's connected by a rail network, and so they're moving. They're wounded, ill and injured by train. And so then it's, how do you equip a train to serve as an ambulance or as as a mobile hospital? And so we're seeing a lot of that. I feel, I boy, I could really, actually talk about this all day. And so in that, one of the small changes, and we published an article on this, there's a device called moves SLC. It's made by a Canadian company, and is a portable ventilator. And it's proprietary, right? It's not a piece of American equipment. It's not a military piece of equipment. They're a civilian company. They were great to us when we were writing our paper. But the reason we wrote a paper exclusively about the utility and interest in moves. SLC was because when we did our interviews with the Ukrainian healthcare workers, they I didn't know what moves was, and it kept coming up. And I would, you know, I'd probe a little, and they'd tell me the good and the bad.

Jim Cardoso: 16:40

They were aware, but they were using it. Oh, absolutely, they were

Tracey Perez Koehlmoos, PhD, MHA: 16:43

100% enamored with it, to the point that my colleague and I, who did the research, we got on the plane to fly back to the States. And I said, we need to get a paper out about moves, because people need to know that this is a capability in military medicine and Battlefield medicine that's now necessary. It didn't exist before it does exist. Now you know it needs to be and I know that there's American units that are testing and investing in moves, the Marine Corps, the 82nd airborne and others, are interested in having this capability and and again, because it's proprietary, there's challenges with if you're in Ukraine towards the front and a piece breaks, how do you fix that? Yeah, if you need more filters, because it's a ventilator, how do you fix that? And so there's a lot of work arounds that have been happening, and actually moves SLC, my understanding is that they've been helpful to the Ukrainians with here. Maybe you 3d print this, right? So that, so that these newer technologies are being used and they're making these tremendous adaptions.

Jim Cardoso: 17:58

You know, one thing that you know, you talked about the trains, and you talked about some of the specifics to the Ukraine Battlefield, and a lot of lessons learned coming from that, you know, as the US looks to the future. I mean, you know, I think we can all agree that the future conflict, it's not going to look like G watt, it's going to be something different, and maybe something like Ukraine, Russia, maybe something different from that, but we're not sure where it's gonna be. And really, I mean, probably the most likely places I think most people would consider would be either the Middle East, Southwest Asia, or the Far East. Even more likely China, the Indo PAYCOM. Okay, so now you're in the Indo PAYCOM. You don't have railways. Rail.

Tracey Perez Koehlmoos, PhD, MHA: 18:46

Don't think it's that the United States is investing in rail cars. I don't think that it's something that we're seeing. Yeah, now

Jim Cardoso: 18:55

I'm tracking that. I guess I'm just saying, I'm I'm just leaning into what. So what, what? So what specific lessons is the US looking at now to structure how it does fight that future fight? So it's taking these lessons from Ukraine, and then what are they doing now to kind of

Tracey Perez Koehlmoos, PhD, MHA: 19:13

right? But there's additional things that we're doing specifically for indo, PAYCOM, right? Yeah, yeah, yeah, where it's water, yeah. So I think it's fairly well known. And again, if we look back at COVID, you know the mercy and the comfort, there was a beautiful shot of, I think, the comfort sailing into New York Harbor, right? They were going to sail in, save the day, alleviate all sorts of challenges being faced in New York at the early stage of the pandemic, when horrible, horrible things were happening there, it didn't quite the shipboard thing didn't work out quite as well as they thought it would. Ships are actually a bad environment for for viral infections. So they ended up standing at the Javits Center, which was great, but the problem. With the mercy and the comfort as a hospital ships is they are big and they're slow, so the US Navy has ordered four or six really rapid dual surgical suite ships, again, with the tyranny of distance. And there's a part of me that doesn't understand how you can be on a ship. I've been on a ship, maybe a cruise ship, but it's, I don't know how you sustain an operating room going over the seas at any amount of speed. So there's definitely, you know that. So that's something that we're working on. We're working on other types of air, back, to be done with more, more air back over that more. I know that the army was testing, almost like a mini Osprey as like a replacement vehicle. And I, I've been, you might know more about that.

Jim Cardoso: 20:54

That's moving forward. Yeah, the the flora, basically, and that's going to be, it's kind of, it's a tilt rotor. It's the same, same concept that technology is a little bit different, produced by the same company which made the Osprey, but yet, hopefully,

Tracey Perez Koehlmoos, PhD, MHA: 21:07

it doesn't suffer from like decades of you know, real challenges in development like the Osprey was not only that the Osprey had, but that the Osprey sort of continues. I love the I love having to work for the Marine Corps. Boy, do I love an Osprey. And

Jim Cardoso: 21:24

you know, truth be told, I was an initial cadre Osprey pilot for the Air Force, so I'm a big fan of the Osprey, but, and I can also say that the the new aircraft, the it's called the v2 80, they've taken the lessons learned from the Osprey, and so they've made some adjustments, which are really smart adjustments to the technology to address them. So I think that that capability, and it's about Black Hawk size, so it should make a really good, you know, medevac platform with the speed of a turboprop aircraft. Well

Tracey Perez Koehlmoos, PhD, MHA: 21:56

and interesting. When I was in Afghanistan, they were usually right at sort of in middle of the war, they started using Ospreys as Cassie back medevac requires you can do something true. Yeah, true. Back, you could just kind of put casualties in there. So there really are efforts underway, because the Asprey is big, but it's, you know, the fact that you can take off and that you can go faster over greater distances again, makes it an ideal if we're looking at war in invacom. Additionally, the United States has really plussed up, not just our hospital at Tripler. Tripler is a major medical center right in Hawaii, right there in the middle of the ocean, but it's the triple is quite far from everywhere. But Guam, where there's a brand new, gorgeous hospital, is like, right there. Yeah, you know, that's great location for us. It is. I mean, capacity that way, it's

Jim Cardoso: 22:55

right there. I mean, it's more right there, but I mean, it's one of those things that I wish they had globes still. They we don't have globes anymore. Remember good old globes they had that's,

Tracey Perez Koehlmoos, PhD, MHA: 23:05

well, I had a globe in my house. Actually, I do have a globe in my house, just I'm at my office right now, so I don't have a globe but, but it's, it's right there, but it's still and I lived, I used to live in South Asia. You know, it's still a five hour flight. It's still a seven hour flight. These are huge distances. When

Jim Cardoso: 23:23

you look at a globe, just when the average person, you know, they think, okay, the Pacific Ocean is kind of big. Look at a globe, and you just realize just how enormous that space is. The specific ocean, Right exactly. And so when you say, I mean, you're right, Guam is quote, it's quote, unquote, relatively, you're right, right there. But no, the distances are, especially in a, in a kazo vac situation, the distances to, and so it does go back to, I think, probably, you know, most likely, some of those lessons that are learned in Ukraine that the point of, you know, the point of injury, there's going to have to be a lot more capability at the point of injury just because of the distances involved, what you think?

Tracey Perez Koehlmoos, PhD, MHA: 24:02

Yes, absolutely so. And that's where we can do more now as well, because we have, well one we have really brilliant and talented medics and corpsmen and, you know, people who are like, right there, when things, things happen, the

Jim Cardoso: 24:20

rest of them is going to be increased too, because they're going to have to be right there on a very lethal Battlefield,

Tracey Perez Koehlmoos, PhD, MHA: 24:27

absolutely. And so really, when we do talk about moving injured people off the battlefield with the drones, it's, do you have, like a drone that folds over someone and gives them oxygen and blood, or it apply some sort of pressure, and those are the sorts of projects that are in testing and development in various stages right now. Yeah, that's not the sort of research that I do, but I do see a lot of that at a different conferences and events that I go to.

Jim Cardoso: 24:58

What other innovations are you. And that'll help prepare the US. You talked a little bit about that, but also some other innovation, maybe seeing that are helping prepare the US for the for the next fight. Either can be technological or just, you know, just people expanding new uses of current technology and capability. What's being innovative out there to prepare us?

Tracey Perez Koehlmoos, PhD, MHA: 25:18

I think that we're doing a lot. So we for medical records. And I'm just going to say this, when we transfer a patient on the battlefield, it's a paper where handing over paper, like a folder, is handed over. That is unacceptable today,

Jim Cardoso: 25:34

today, that's still happening in

Tracey Perez Koehlmoos, PhD, MHA: 25:37

this moment. Wow, right now. And our partners from Israel. Israel is a great partner to the United States in terms of like, military medical innovations. What they're doing is they had a hold. For those of you who can't see because you're watching at home, that's, you know, we can often transfer data from cell phone to cell phone. So they quickly pioneered their their surgeon general rolled out the he said, he's like, we're not doing this anymore. We have to be better than this, because some of the gaps are it's you need to know the injuries in a case before that case arrives, so that you can be prepared to receive and operate on that case. You also need that data so that you can quickly assess the types of injuries taking place, not just at the individual but across your your fighting force. So again, so you can prepare and adapt from from these systems. But what he would the Surgeon General of Israel said was, we're not doing this paper thing anymore. So now it's, it's cell phone touching cell phone at the patient handoff point that they just lay them on top of each other, and they're, they're done. They've moved on. And I, I know that we have to get to yes to where we allow these sort of technological or AI and other innovations into our data system as a United States like we really struggle as a DOD to strike that balance between protecting, particularly for health care, protecting the health care data. But sometimes, if we protect too much, you can't use that data to inform process improvement and decision making and improve care, whether it's back in the United States or on the battlefield. So those are some places where we are,

Jim Cardoso: 27:33

yeah, you know, I mean, and so you talked about this earlier, but a lot of times, if people think about, you know, challenges on the battlefield, it's the lethality, it's the weaponry. It's the drones. We don't have air superiority. We probably won't have air superiority in future, near peer, adversary conflict. But you touched on it earlier, too, about like, kind of the command and control capabilities, and then what you're talking about now, transfer of data, the kind of the data centric stuff, is equally challenging. And sometimes when people think about medicine, that's not what they think about. They think about. They think about the tactical, you know, providing care, operating, you know, treating wounds and everything like that. But if you don't have this, the command and control capability, which is going to be compromised, and you don't have the data transfer capability, I mean, you could almost be doing more harm than good in some cases.

Tracey Perez Koehlmoos, PhD, MHA: 28:19

Now is with our Ukraine work. It wasn't just that. We looked at like injury, Injury Prevention, disease, non battle injury. We also looked, I'm a health system scientist. So we looked holistically at the logistics, how, how things came in, supplies came in, how people came out. We looked at the organization of services. We looked at what telehealth really meant. We looked at blood products and pharmaceutical safety and quality. How are we getting what we need to the battlefield? You know, do we need TSA and medics kits and that? So really looking at what's needed in the future, and also looking at the health and wellness of your service members, right? It's one of the things that we took out of Ukraine, is they've been at war for a long time. You know, the sort of the young people who were enthusiastic and joined up it's to serve at first, there's been a lot of injuries there, and so you have an older fighting force that's less fit. So you've got people with hypertension, on hypertension meds, with lymphedema, on meds for that, yeah, with diabetes. So you've got, you've got the army of the willing out there with and with enthusiasm, with whatever medical challenges they were facing prior to going into the armies, into the front for Ukraine. So it is, yeah, it's a different whereas we have the luxury as a United States to say, Listen, you know, your blood pressure is not under control. You're not deployable, or you or you have diet. 80s, you can't join and they not that that's a luxury, yeah,

Jim Cardoso: 30:05

and in a future, near, peer, adversary conflict, we may not have that luxury, either we may need you know more well able bodied or close to able bodied people.

Tracey Perez Koehlmoos, PhD, MHA: 30:15

I'm gonna cut you off. We are a society right now. Today, we're fewer than 25% of people of enlistment age are qualified to serve. Oh, that's you're

Jim Cardoso: 30:28

absolutely right. I've heard that before, too. Yeah, right.

Tracey Perez Koehlmoos, PhD, MHA: 30:31

We I publish on that we don't have the humans in this country to meet our recruiting goals rather routinely, with the exception of the Army, right? I know we're going over time, with the exception of the army rolling out the program where they can bring service members. Would be service members in the soldier prep program, teach them how to pass the asvab, give them some academic help, and then also get them physically fit enough to serve, because obesity is a huge reason. Obesity in today's youth is a huge reason that people can't serve,

Jim Cardoso: 31:08

but that soldier prep program is a band aid. I mean, I mean that, you know, that can't be the long term solution for I agree with, I mean, I finally agree with you right now,

Tracey Perez Koehlmoos, PhD, MHA: 31:17

but we're doing what other countries do, only in reverse. So when I believe, when my husband was the defense attache in Bangladesh, Bangladesh had a program where they would bring in undernourished young men, undernourished young men who wish to be soldiers, and they would get them nourished and to full fitness. Whereas we're doing we're taking in those

Jim Cardoso: 31:39

we have to study. We have to skinny them out. We I and

Tracey Perez Koehlmoos, PhD, MHA: 31:44

perhaps in our society, where dense calories are cheap calories, right? Yeah, where we teach them about nutrition, we teach them like holistic fitness and health in a way that they were never taught in school. And of course, to prepare for that the Army, Navy, Air Force, Space Force and Marine Corps. Can't do it alone. It requires a whole national security like that requires a whole government approach. Bring back the Presidential physical fitness test in every school in America. Make those kids run the mile once a year, right? Those who are fit, we stopped giving kids awards for physical fitness, yeah, grade school because it made other children feel badly. Well, awards do make other people who don't want awards feel badly. We need to get back on the track of having and this is my public health part. There'll be no soldiers if there's no health in today's youth, we've got to get back to fitness.

Jim Cardoso: 32:46

There's a researcher here at one of our research here in GNSI. He does a lot on on recruiting military society. Is another researcher here, USF at large, dr, Lisa Rossiter. She you and her would have a very, very good conversation. Because, I mean, I'm almost talking to her right now when I listen to you, she's exactly the same way, and kind of that holistic and whole of, not a whole government, whole of society, approach to be able to enable us to feel the force that we may need in the future,

Tracey Perez Koehlmoos, PhD, MHA: 33:14

right? You know, but it's also, it's a force that we need right now. Yes, yes. Let's be really clear. We've published papers with some of my you may have heard, I don't know, in April 2023, there's something about 10,000 more soldiers with obesity coming out of COVID 19, well, it's 20,000 more now, because we just updated the paper, and being obese, if you're on active duty, is not benign. Musculoskeletal injuries are the leading cause of lost duty days and active duty service members and when the and the bodies of soldiers, bless them, are not different from the bodies of other humans. Because there's some belief that there's magic in wearing the uniform, that somehow, anatomically and biologically, you are now different. And it's true, the blood cells in my body are army green, singing the Army song, marching in formation. Sing right now, but the reality is

Jim Cardoso: 34:08

minor Air Force blue, but continue. Okay,

Tracey Perez Koehlmoos, PhD, MHA: 34:11

there you go. Not sure I'm understanding that, but it's when as body mass index and body fat percentage creep up in service members, their risk of getting a musculoskeletal injury, leading cost of lost duty days skyrockets so that it is a real national security risk to us, not just from those who will serve in the future, but from those for those who are serving with us right now, and that doesn't make me the most popular girl at the working group. I assure you, when I roll into the DoD body composition working group, they're like, Why do you hate us? I'm like, I don't hate you. I don't want you to get hurt.

Jim Cardoso: 34:55

I will. I will say for the people listening to this, next time we do this with. With her. We're gonna, we're gonna get a virtual because if it's too bad you're not enjoying the visual flair of the emotions that are coming through as I'm watching her speak right now. But it's really, it's great to hear. I mean, I like it. It's a, it's a, it's a message that is, that is needed to be heard. And I think it's a great point you make. It's not just a future problem. It's a now problem. But before we we are a little over, but I want to give you a chance, because we spoke yesterday, and you talked about the importance of the safety and quality of the pharmaceutical supply chain. Is something you're very passionate about. You feel is very important in the associated national security challenges that go with that. I want to give you a chance to talk a little bit about that before we end the podcast. You

Tracey Perez Koehlmoos, PhD, MHA: 35:37

know, there's the part of me that thinks you need to have me back in a couple months,

Jim Cardoso: 35:41

we may do that. Yeah, that's not a bad idea. The teaser I

Tracey Perez Koehlmoos, PhD, MHA: 35:45

will give all of you is we have offshored the creation of the ingredients because, because when you make a pill, any pill, a brand name pill, a generic pill, it's a recipe. Think of it as, like my I have a chocolate chip cookie recipe, and when the drug that is tested is the brand name, original recipe, when my drug comes off a patent, it means that anybody else on the planet can make that drug. But I always believed, until I started really working in this space, that I had a chocolate chip cookie recipe, and when I came off patent, you and everyone else had my chocolate chip cookie recipe, and you can make my same chocolate chip cookies. That is not what generic drugs are. It's it's that you take, you eat my cookie, or you see what's going on, you dissect my cookie and backwards engineer, so, you know, there's some sort of chocolate chip, and then, you know, there's some other activating ingredients in there, and then you fill it up with whatever you want. And a lot of our generics come from ingredients that are sourced in China. We go to war. Is China going to be selling us low cost antibiotics and low cost pharmaceutical products? And you just, I'm going to leave you with that I am happy to come back with. This is work that we're doing with the White House right now.

Jim Cardoso: 37:19

Yeah, I'm cogitating on what the future podcast is going to look and sound like, and I have some ideas already that are popping in my head. So, yeah, that's a good, good teaser, good teaser trailer that we can provide to everybody any but as we do wrap up any final comments on what we've been talking about today, before we wrap up the podcast, no,

Tracey Perez Koehlmoos, PhD, MHA: 37:39

not at all. I want to thank you Jim and USF for having me back. Go Bulls, and have a great afternoon, evening, morning, depending on wherever our listeners. So thank you. Yeah, thank

Jim Cardoso: 37:51

you. Thank you for your time. And we'll add to that, Go Bulls. Many thanks today to Dr Tracy Perez colmus, a director at the Uniformed Services, University of the Health Sciences, and proud USF alumni, we were fortunate to be able to connect with her this week and really enjoy the conversation today, next week, on at the boundary, we'll be talking with Danish Colonel Alan Peterson, who holds a position that many are likely unfamiliar With, chairman of the coalition at US Central Command, we're going to find out what it's like for him to be posted at CENTCOM and chairing one of the largest military coalitions in history. The coalition formed following the 911 terrorist attacks with a common purpose to fight terrorism, but has since grown to 46 countries working with CENTCOM to promote peace and stability in the Middle East, Southwest Asia and beyond. It's going to be a great conversation you don't want to miss. Thanks for listening today. You like the podcast, please subscribe and let your friends and colleagues know, and if you have an idea for a future podcast, we'd love to hear from you. There's a link in the show notes to get in touch with us. You can follow GNSI on our LinkedIn and X accounts at USF, underscore GNSI, and check out our website as well at usf.edu/gnsi, while you're there, don't forget to subscribe to our monthly newsletter. That's going to wrap up this episode of at the boundary. Each new episode will feature global and national security issues we found to be insightful, intriguing, maybe controversial, but overall, just worth talking about. I'm Jim Cardoso, and we'll see you at the boundary.