1. UNCLASSIFIED Damon Cardenas/ MCFA (210) 221-7988 (DSN 471) /Damon.Cardenas@us.army.mil30 Jun 08 Slide 1 of 12 MEDCOM SUSTAINABILITY STRATEGY OVERVIEW Damon V. Cardenas Chief, Environmental Management HQ MEDCOM COMM (210) 221-7988/DSN471-7988

2. UNCLASSIFIED Damon Cardenas/ MCFA (210) 221-7988 (DSN 471) /Damon.Cardenas@us.army.mil30 Jun 08 Slide 2 of 12 MEDCOM SUSTAINABILITY MISSION – TSG Challenges (13 Dec 07) “Sustain”: Implementation of the Army Family Covenant “Prepare”: Building and sustaining a comprehensive, life-cycle management approach “Reset”: Execution of the Army Medical Action Plan “Transform”: Deliver the maximum value in healthcare and other services

3. UNCLASSIFIED Damon Cardenas/ MCFA (210) 221-7988 (DSN 471) /Damon.Cardenas@us.army.mil30 Jun 08 Slide 3 of 12 MEDCOM Sustainability Program Overview Emerging MEDCOM program – MTF focus Ensure MEDCOM is proactive in addressing potential encumbrances (25 yrs into the future) Theme: Sustain the Mission – Secure the Future Triple Bottom Line – Plus: Mission, Environmental, Community and Economic Success Multidisciplinary Approach – All directorates Funding requested for: baseline data, marketing, assessment of Best Management Practices, planning, implementation

4. UNCLASSIFIED Damon Cardenas/ MCFA (210) 221-7988 (DSN 471) /Damon.Cardenas@us.army.mil30 Jun 08 Slide 4 of 12 MEDCOM SUSTAINABILITY Proposed MEDCOM Sustainability Strategy Vision - To meet current as well as future mission requirements worldwide, safeguard human health, improve quality of life, and enhance the natural environment Mission - Reduce life cycle costs, Minimize adverse impacts, Enhance human health, safety, and well-being, Be an active citizen within our communities, do more and do it better Goals – Minimize impacts and total ownership costs, Enhance the well-being of our Soldiers, civilians, families, neighbors and communities through leadership in sustainability Health Care Industry Leader in Sustainability

5. UNCLASSIFIED Damon Cardenas/ MCFA (210) 221-7988 (DSN 471) /Damon.Cardenas@us.army.mil30 Jun 08 Slide 5 of 12 MEDCOM SUSTAINABILITY National Health Care Footprint 16% of U.S. economy devoted to healthcare $6,500/person/yr ($2 trillion in 2005) 4% of national square footage 4 th Highest energy user by building type Consumes 8% of national energy 5 Million tons of waste/year Regulated Medical Waste –750,000 tons/yr (MEDCOM = 1,500 tons/yr) – Largest source of dioxin air pollution –10% of mercury air emissions

6. UNCLASSIFIED Damon Cardenas/ MCFA (210) 221-7988 (DSN 471) /Damon.Cardenas@us.army.mil30 Jun 08 Slide 6 of 12 MEDCOM SUSTAINABILITY STRATEGY On-Going Initiatives Product Substitution: –Mercury - Completed CONUS hospital inventory. Two Hospitals (TAMC & MAMC) received award for virtual mercury elimination. –Hand Sanitizer – Change in alcohol content changes waste classification Operation Issues: –CONUS RMW contract, economies of scale –Reprocessing of surgical equipment, standardization –RMW – Sharps processing, reusable containers –Vyleater – HIPPA Compliance/Waste reduction Process Change: –Ethylene Oxide Sterilizers – All removed from hospitals –Regulated Medical Waste Incinerators - All hospital incinerators closed –X-Ray Wet Chemical Processing – Converting to Digital imaging Systems Engineering Controls: –Recycling/Re-utilization - of Hazardous materials, such as xylene and formaldehyde –Implement available strategies – decreased energy consumption

7. UNCLASSIFIED Damon Cardenas/ MCFA (210) 221-7988 (DSN 471) /Damon.Cardenas@us.army.mil30 Jun 08 Slide 7 of 12 MEDCOM SUSTAINABILITY LEED PROGRAM Army directive - LEED Silver Program elements –Optimize Site Potential –Optimize Energy Use –Protect & Conserve Water –Use Environmental Preferable Materials –Enhance Indoor Environmental Quality –Optimize O & M Practices (standardization) Less than 3% of healthcare facilities sought LEED certification (CY06) Actual benefits - 6% of the 2.5M healthcare patients each year afflicted with hospital acquired infection attributed to design/construction/O&M practices "It costs a lot of money to build a poor hospital, and only a little more to build a better hospital." - architect Robin Guenther

8. UNCLASSIFIED Damon Cardenas/ MCFA (210) 221-7988 (DSN 471) /Damon.Cardenas@us.army.mil30 Jun 08 Slide 8 of 12 MEDCOM SUSTAINABILITY Community Patient perception - decrease stress, increase comfort, quicker recovery Employee perception - 90% of hospital operating cost is on salaries, retain people Public perception - good neighbor/public comment Actual issues – e.g. WRAIR noise Notice of Violation Participate in non-DoD environmental organizations (Energy Star Recognition, EPA Performance Track/Lab 21/Practice Green Health)

9. UNCLASSIFIED Damon Cardenas/ MCFA (210) 221-7988 (DSN 471) /Damon.Cardenas@us.army.mil30 Jun 08 Slide 9 of 12 MEDCOM SUSTAINABILITY Benefits Minimize adverse impacts to mission Safer/Healthier working environment Decrease in staff turn-over Reduction in hazardous materials usage Waste stream reduction Reduced facility life cycle costs Enhanced environmental management Positive community relations

10. UNCLASSIFIED Damon Cardenas/ MCFA (210) 221-7988 (DSN 471) /Damon.Cardenas@us.army.mil30 Jun 08 Slide 10 of 12 MEDCOM SUSTAINABILTY WAY AHEAD Procurement –Hazardous Materials Management Program –Green Procurement Implement institutional changes of Best Management Practices (Standardization) Survey community opinion Infrastructure analysis Contingency planning Regulatory surveillance

11. UNCLASSIFIED Damon Cardenas/ MCFA (210) 221-7988 (DSN 471) /Damon.Cardenas@us.army.mil30 Jun 08 Slide 11 of 12 MEDCOM SUSTAINABILITY PROGRAM WAY AHEAD - Programs Improve Waste Management –Conduct hospital waste management studies –Mercury phase out to continue –Solid waste diversion Implement LEED Silver Criteria –New construction –Existing building Implement Energy and Water conservation initiatives –Energy facility audits –Energy Star Portfolio –Energy Conservation Investment Program (ECIP)

12. UNCLASSIFIED Damon Cardenas/ MCFA (210) 221-7988 (DSN 471) /Damon.Cardenas@us.army.mil30 Jun 08 Slide 12 of 12 MEDCOM SUSTAINABILTY Way Ahead Assess Impacts/Aspects Collect baseline information (surveys/plans/materials) Develop/Implement strategy (marketing) Develop/Formalize MEDCOM Sustainability Policy Implement initiatives