Innovations in Military Medicine: Interview with leaders from Mayo Clinic Military Medicine

Innovations in Military Medicine (Part 1 of 2): Interview with Mayo Clinic’s Pierre Noel, M.D. and Thomas Flipse, M.D.

January 12, 2022 – By Jared Mueller, Director – Mayo Clinic Innovation Exchange

Active-duty service members and retirees often have distinct medical needs from civilian patients. For example, forward-deployed members of the armed forces may regularly find themselves receiving care in challenging, highly resource-constrained settings. To better serve these patients, Mayo Clinic formed the Mayo Clinic Center for Military Medicine in 2018, with Pierre Noel, M.D. serving as the Center’s inaugural director. The Arizona-based Dr. Noel is joined in the Center’s medical leadership by Thomas Flipse, M.D. and Christopher Russi, D.O., who lead the Center’s work on Mayo Clinic’s campuses in Florida and the Midwest, respectively.

Dr. Flipse and Dr. Noel shared details on the Center for Military Medicine’s work in an exchange this winter. This article is part one of a two-part series featuring the work of Mayo Clinic Military Medicine. Read part two for more innovations in military medicine.

Dr. Noel is a retired U.S. Air Force Lt. Colonel and a physician in Mayo Clinic’s Division of Hematology and Oncology. He is a professor of medicine within the Mayo Clinic College of Medicine and Science. Dr. Noel has served as a primary consultant in protective medicine for the White House Medical Unit and as a senior visiting fellow at the Brent Scowcroft Center for Strategy and Security.

He has held leadership roles at the National Institutes of Health, including serving as the acting director of Security and Emergency Response, and at the U.S. Department of Health and Human Services, focusing on disaster recovery and pandemic response planning. Following 9/11, he worked with Military Special Mission Units and the White House Homeland Security Council. Dr. Noel is an alumnus of McGill University and the Université de Sherbrooke Faculty of Medicine.

Dr. Flipse is a U.S. Navy Captain and continues to serve in the Naval Reserve. He is an electrophysiologist in Mayo Clinic’s Department of Cardiovascular Medicine in Jacksonville, Florida. During his time in the Navy, he has served as a Flight Surgeon for a combat helicopter squadron during Operation Iraqi Freedom. Dr. Flipse has held three certifications in the Navy: aviation medicine, cardiovascular disease, and internal medicine. He has also served as an Aviation Medical Examiner for the Federal Aviation Administration and is a Federal Air Surgeon Cardiology Consultant. Dr. Flipse is an alumnus of Duke University and the University of Miami Miller School of Medicine.

Q: How has Mayo Clinic expanded its work with active service members and military veterans over the last 20 years?

PN: Ten years ago, we established a Special Operations Tactical Medicine Training Program at Mayo Clinic for military Special Mission Units. The program has gone on to train more than 1,000 special operations personnel in combat trauma, prolonged field care and critical care. Our students are principally seasoned special operations medical personnel with significant combat experience.

Many of the simulations take place next to abandoned buildings or in special containers in the Arizona desert, to mimic the austere environments in which many combat missions and episodes of care take place.

We are recipients of Department of Defense research grants in military education and partner closely with industry in developing medical devices serving our service members.

Q: Both Arizona and Florida rank among the top 20 U.S. states when it comes to veteran populations per-capita. How is Mayo Clinic approaching its veterans health work in the coming years?

TF: I practice medicine in Jacksonville, which has been ranked one of the ten best communities for veterans in the country. Jacksonville is also home to the third-largest domestic U.S. Navy base: one consequence of the Naval presence is that I am one of tens of thousands of active-duty or retired Navy personnel in the region — setting aside individuals from other military branches. In 2020, Mayo Clinic Florida took on the task of providing COVID-19 testing for the U.S. Navy in the Southeast Region.

That same year Mayo Clinic was honored to join the Department of Veterans Affairs’ (VA) Community Care Network, which has enabled more veterans requiring complex care that can uniquely be served by Mayo to receive care at one of our sites in Arizona, Florida, or the Midwest. Several of our nursing reservist colleagues also provided care onboard the USNS Comfort during the peak of New York’s initial COVID-19 surge in spring 2020.

The many hundreds of veterans and reservists at Mayo Clinic are eager to find ways to expand Mayo’s work with active service members and veterans alike. My Navy experience has informed my research into the cardiovascular health needs of military aviators: many of our Mayo colleagues are also actively pursuing research agendas that serve both patients’ needs, and the national security interests of the United States and its allies.

Q: Which other expansions of care did the 2020 agreement between the VA and Mayo Clinic make possible?

PN: The VA operates a number of healthcare facilities in the Upper Midwest, much as Mayo Clinic does, but some of these services are less convenient to veterans living outside larger cities. The 2020 entry of Mayo Clinic into the Community Care Network means the VA is now able to authorize more visits to Mayo sites for veterans for whom care at a Mayo Clinic Health System site is more convenient than traveling longer distances to a VA hospital. VA patients with complex care issues who are referred by the VA now can be seen at Mayo Clinic’s three major campuses in Rochester, Jacksonville, and Scottsdale/Phoenix.

Q: What breakthrough innovations in healthcare delivery or technology excite you most?

PN: I believe that telemedicine and telerobotics are crucial components of battlefield medicine in the next decade.

TF: An area that is particularly promising is the use of telemedicine and telerobotics to expand specialty care to remote duty stations, ships at sea, and potentially the battlefield environment. Dr. Dave Freeman at Mayo Clinic in Florida has been exploring the potential of this technology in collaboration with the Department of Defense, and has started a fellowship to train military physicians in its use.

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