1. AMSUS GHE Panel 28 November 2017 RADM Brian S. Pecha Command Surgeon
Good morning distinguished guests,
I’m RADM Pecha and I’ll deliver the PACOM Surgeon's Overview This briefing is at the: Unclassified Level and FDO approved.
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2. Command Mission
USPACOM protects and defends, in concert with other US government agencies, the territory of the United States, its people, and its interests. With allies and partners, we will enhance stability in the Indo-Asia-Pacific region by promoting security cooperation, responding to contingencies, deterring aggression, and, when necessary fighting to win.
This slide represents USPACOMs mission and one element of our strategic plan. USPACOM is one of six (6) geographic combatant commands in charge of integrating Army, Navy, Air Force and Marine Corps forces within the area of responsibility to achieve national security objectives while protecting national interests.
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3. Combatant Command Structure
U.S. Pacific Command
U.S. Army
Pacific
Pacific
Air Forces
Marine Corps Forces
Pacific
Pacific Fleet
Special Ops Cmd Pacific
U.S. Forces Korea
U.S. Forces Japan
1. Headquarters U.S. Pacific Command is comprised of four (4) Component Commands represented by: U.S. Army Pacific, Pacific Air Forces, Pacific Fleet, and Marine Corps Forces Pacific.
2. Also represented are three (3) Subordinate Unified Commands: Special Operations Command Pacific, U.S. Forces Korea, and U.S. Forces Japan.
3. Joint Interagency Task Force – West: executes Department of Defense’s counter drug activities on behalf of Commander USPACOM.
4. Center for Excellence in Disaster Management and Humanitarian Assistance: Advises USPACOM leaders, enable focus engagements, training, education; and increase knowledge of best practices to enhance US and international civil military preparedness for disaster management.
All these organizations are located on Oahu.
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Joint Interagency
Task Force West
Center for Excellence
in Disaster Management and
Humanitarian Assistance

4. J07 Directorate Organization
PACOM Surgeon
(RADM Pecha)
Flag Officer Aide
Deputy Surgeon
(COL Teyhen)
MED LOGISTICS & RESOURCES
MED OPS/PLANS
GLOBAL HEALTH ENGAGEMENT
FORCE HEALTH PROTECTION
ALIGNS: J1/J4/J8
Health Service Logistics
- Resource Management
- Manpower
- Budget / Finance
- Med Logistics Management
- Joint Blood Program
- Critical Infrastructure Program
- N.E. Asia Med LNO
ALIGNS: J2/J3/J4/J5
Current / Future Ops
Plans and Exercises / Readiness
Patient Movement / TPMRC
- Orders
ALIGNS: J4/J5/J8/J9/FPA
- Asia Pacific Mil Health Exchange
- Health Annex to the Theater Campaign Plan
- Assessments
Health TSC Planning
ALIGNS: J2/J9
- Force Health Protection
- Deployment Guidance
- Infectious Disease
Clinical TSC Planning
Defense HIV Prevention
This is a snap shot of how the USPACOM Surgeon Office is structured and comprised of four (4) branches: Medical Logistics & Resources, Medical Operations & Plans, Strategic Health Engagements and Force Health Protection.
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Effective OCT 2016

5. Joint Health Value to PACOM
J07 Priorities
COM’s Priorities
J07 Priorities
Defend the Homeland
Support to the Warfighter
Be Ready to Fight Tonight
Focus and Commitment to Indo-Asia-Pacific Region
Joint Health Value to PACOM
Global Health Engagement
Have Unity of Purpose
The PACOM Surgeon priorities are synchronized with the Commanders strategic priorities in an effort to collaborate joint health care solutions with our partners and allies in the Indo-Asia-Pacific region.
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Operationalize Theater C2
Work with Components
Optimize Our Organization

6. USPACOM Characteristics
Over half of world population (3.43 B)
52% of Earth’s surface
36 countries
16 time zones
Most populous nation
Largest democracy
Largest Muslim- majority
Smallest republic
The Pacific Ocean connects the United States to the region… it doesn’t separate us
The slide show represents the six (6) geographic combatant commands, highlighted in blue is USPACOM.
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2 of 3 largest economies
9 of 10 smallest economies
World’s 6 largest armed forces
5 of 7 U.S. Mutual Defense Treaties
5 declared nuclear nations
Busiest international sea lanes
9 of 10 largest ports
US NORTHCOM
US SOUTHCOM
US AFRICOM
US EUCOM
US CENTCOM
US PACOM

7. Regional Threats to Health
Emerging Infectious Diseases
Antimicrobial Resistance
Counterfeit Pharmaceuticals
Water Quality
Human Trafficking
Animal Trafficking
Non-Communicable Diseases
PACOM
There are numerous health threats in the Indo-Asia-Pacific region, many are without boundaries and would have significant impact to the overall security within the region. Multinational collaborative efforts are needed to address these issues and thus improve security and stability.
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Natural Disasters
Climate Issues
High Population Densities
Territorial Disputes

8. Theater Campaign Plan (TCP) Theater Security Cooperation Plan (TSCP)
UNCLASSIFIED//FOUO
Theater Campaign Plan (TCP) Theater Security Cooperation Plan (TSCP)
Shared
Domains
Allies & Partners
Homeland
Defense
China
North Korea
Counter Weapons of Mass Destruction
Counter Terrorism
All Hazards
India
Maritime
Space
Cyberspace
Legend
USG Desires (ICS, IA)
Partner Desires
Allied Contributions
US Industry
Intermediate Military
Objectives (IMOs)
This slide is a visual representation of the PACOM Theater Campaign Plan (TCP) 11 lines of effort. Above this is the GEF, with campaign objectives that guide development of the TCP. There is no single TCP LOE where “health” falls, rather health can support multiple LOEs. Within the TCP there are intermediate military objectives, as well as specific country objectives that are within the Allies and Partners Line of Effort. The country objectives are informed by other USG desires (Integrated Country Strategy, strategic documents from the interagency), and the country objectives and IMOs inform the Country Security Cooperation Plans. We contribute to development of the Theater Campaign Plan (latest TCP awaiting publication) to ensure health equities/considerations are included in the appropriate Lines of Effort.
Also mention annual Theater Campaign Order, which operationalizes the TCP. FY16 MOD1 and FY17 TCO have recently been published; we insert health-specific tasks into that document.
Country Objectives
(COs)
Country Capabilities
(CCs)
Health Annex- CSCPs
CSCP = Country Security Cooperation Plan
Country Security Cooperation Plans (CSCPs) Drive at Building Country Capabilities

9. Health Theater Security Cooperation Plan (Annex to TSCP)
UNCLASSIFIED//FOUO
Health Theater Security Cooperation Plan (Annex to TSCP)
Health TSC Guidance
- Focus on Mil-Mil, Mil-Mil-Civ - Build Capability, Capacity, & Interoperability - Optimize Multilateral Opportunities
- Caution on Direct Patient Care - Synchronize with USG Interagency - Support TCP IMOs
Health Lines of Effort (HLOE)
HLOE: Operational Medicine
Aeromedical Evacuation
Dive/Undersea Medicine
Trauma Casualty Care
HLOE: Public Health/Force Health Protection
Preventive Medicine
Emerging Infectious Diseases
Malaria Elimination
HLOE: Health System Support
Blood Safety Program
Health Admin/Logistics
Maternal/Child Health
Allies & Partners
China
India
All Hazards HD CT
Shared Domains
DPRK
CWMD
Example:
This slide is a visual of our health TSC annex to the TCP (published Dec 14). It provides overall guidance (top box), and then provides prioritization of Health Lines of Effort per country. The prioritization was based on PACOM priorities, Integrated Country Strategy priorities, baseline health data. Our health engagements directly support four of the PACOM TCP Lines of Effort (Allies and Partners, China, India, All Hazards) and indirectly support the others (Homeland Defense, Counter-WMD, Counter-Terrorism, 3 Shared Domains, and North Korea). Vietnam is used as an example, where our primary Health Line of Effort is Operational Medicine, secondary is Public Health/Force Health Protection, and tertiary Health System Support. Health engagements support Country Security Cooperation Plan (CSCP) capability development priorities. Of the CSCP priorities there is no specific “health” bin, but health lines of effort/functional areas support many of the designated capability bins such as HADR, Access, PKO, Interoperability, International Cooperation, and Defense Reform/Professionalization. By aligning our health engagements with TCP and CSCP priorities we are supporting the strategic objectives of PACOM and of the US country team.
J07 needs to rewrite health TSC strategy; starting this work to refine strat guidance.
Support CSCP Capabilities
-HADR -Interoperability
-Access -Int’l Cooperation
-PKO -Defense Reform
UNCLASSIFIED//FOUO

10. USPACOM Health Lines of Effort
Operational Medicine
First Responder Training/Trauma Casualty Care
Medical Support to HA/DR
Naval/Undersea Medicine
Aerospace Medicine
Patient Movement: CASEVAC, MEDEVAC, AEROVAC
Public Health / Force Health Protection
Malaria/Dengue
Emerging Infectious Disease
Biosurveillance/Lab Capacity Building
One Health (Animal, Human, Environmental)
Health System Strengthening
Blood Safety Program
Medical Education Support
Maternal & Child Health
1. These are the Health Lines of Effort USPACOM is focused on and mitigate the regional health threats:
a. Operational Medicine: encompasses our mil-to-mil engagement on military health topics.
b. Public Health / Force Health Protection: includes mil-to-mil as well as mil-civ and whole of government. Addressing these issues in our partner nations will improve US Force Health
Protection, as well as that of our partner nations.
c. Health System Strengthening: may be mil-mil or mil-civ, and focuses on building partner nations’ health systems. Direct patient care activities tend to fall in this line of effort.
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11. USPACOM Health Engagements
OCT 2013 to OCT 2016
REGION
# OF EVENTS
COUNTRIES
Northeast Asia 48
China, Japan, Mongolia, South Korea, Chinese Taipei
Southeast Asia
181
Brunei, Burma, Cambodia, India, Indonesia, Laos, Malaysia, Philippines, Singapore, Thailand, Vietnam
South Asia
Bangladesh, India, Maldives, Nepal, Sri Lanka
Oceania 45
Australia, Fiji, FSM, Kiribati, New Zealand, PNG, RMI, Samoa, Solomon Islands, Tonga
This slide depicts a three (3) year snap shot of USPACOM Health Engagements health related events conducted from October 2013 to October 2016.
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(these numbers under-represent Northeast Asia engagement on a day to day basis between our forces in Japan and Korea and their counterparts)
J07 Engagements
322 Engagements in three years
Asia Pacific Military Health Exchange (APMHE)
International Committee of Military Medicine (ICMM)
Center for Strategic and International Studies (CSIS)
Uniformed Services University of Health Sciences (USU)
Naval War College
Association of Military Surgeons of the United States (AMSUS)
Regional Malaria Meeting (Cambodia)
Global Fund Malaria Meeting (Vietnam)
Visits to Australia, Burma, India, Japan, Malaysia, Philippines, South Korea, Singapore, Thailand, Vietnam
Hosted SGs from India, Indonesia, PRC, Singapore, Taiwan, Thailand in last three years
Types of engagements include:
Blood Program
Disaster Response Exercise & Exchange
Malaria reduction
Field Training Exercise
Pacific Angel / Pacific Partnership / Pacific Pathways
Senior Leader Visit
Subject Matter Expert Exchange
Veterinary
Workshop / Seminar / meeting
Multiple levels of engagement opportunities with military and civilians during international or US domestic events.
TYPES OF ENGAGEMENTS
Blood Program
Senior Leader Visit
Disaster Response Exercise & Exchange
Subject Matter Expert Exchange
Malaria Reduction
First Responder Training
Field Training Exercise
Veterinary
Pacific Angel / Pacific Partnership / Pacific Pathways
Workshop / Seminar / Meeting 10

12. Asia Pacific Military Health Exchange (APMHE)
Co-hosted by PACOM Surgeon & Partner Nation Surgeon
Vietnam (2015) -- Malaysia (2016) -- Singapore (2017) -- China (2018)
400+ participants from 28+ countries, E-4 to O-9
Physicians, Nurses, Medical Service, Public Health, Veterinarians
Objective: To exchange best practices in military medicine, and promote global health security in the Indo-Asia-Pacific region through senior military medical leader engagement, and professional development of up-and-coming military medical officers and non- commissioned officers.
Information on APMHE

13. APMHE Participants 9/5/2018 31 Nations have attended APMHE
No historical participation
APMHE Participants
31 Nations have attended APMHE
* China attended APMHE 16 and 17, Co-host for APMHE 18
** Taiwan attended APMHE 15-17
*** Russia attended APMHE 17, unilateral invite from Singapore
**** Chilean delegate at APMHE 17
UNITED KINGDOM
RUSSIA
CHILE
N. KOREA
BHUTAN
MONGOLIA
S. KOREA
CAMBODIA
JAPAN
THAILAND
CHINA
CANADA
BURMA
TAIWAN
BANGLADESH
UNITED STATES
VIETNAM
NEPAL
PHILIPPINES
PALAU
INDIA
40+ FO/GOs/SES and over 400 delegates from 28+ nations per year
MICRONESIA
BRUNEI
LAOS
MARSHALL ISLANDS
SOLOMON IS.
SRI LANKA
KIRIBATI
PAPUA NEW GUINEA
NAURU
MALDIVES
TUVALU
VANUATU
MALAYSIA
AUSTRALIA
FRANCE
FIJI
SINGAPORE
SAMOA
INDONESIA
TONGA
TIMOR-LESTE
NEW ZEALAND
UNCLASSIFIED

14. Military-to-Military Health Engagement
HA/DR
Patient Movement
In PACOM we are working with our allies and partners every day to increase our bilateral and multilateral interoperability for response to crisis. Some highlights of recent engagements include: HA/DR, Patient Movement/Aviation Medicine, and clinical & surgical medicine.
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Clinical & Surgical Medicine 11

15. Summary
Health engagements have evolved over the last 5 years from largely direct patient care to enhanced focus on building partner nation capacity, capability and interoperability.
Military medical exchanges between the US and partner nations are important for building strong relationships between our great nations and for promoting continued regional security.
Medical educational and institutional exchanges between the US and partner nations will enhance both countries’ understanding of each other’s medical practices.
I will conclude my potion of the overview brief with three (3) take-away points to help bridge future medical collaboration between the US and partner nations. These points focus on strengthening our medical exchanges and medical practices.
Thank you. 14

16. Questions?