Strategies to Protect the Health of Deployed U.S. Forces

Medical Surveillance, Record Keeping, and Risk Reduction

Author: Guze, Samuel B.; Russell, Philip K.; Joellenbeck, Lois M.
Publisher: National Academies Press
ISBN: 9780309066372
eISBN Pdf: 9780309571401
eISBN Epub: 9780309172523
Place of publication: United States
Year of digital publication: 1999
Month: January
Pages: 297
Language: English

Caption

Nine years after Operations Desert Shield and Desert Storm (the Gulf War) ended in June 1991, uncertainty and questions remain about illnesses reported in a substantial percentage of the 697,000 service members who were deployed. Even though it was a short conflict with very few battle casualties or immediately recognized disease or non-battle injuries, the events of the Gulf War and the experiences of the ensuing years have made clear many potentially instructive aspects of the deployment and its hazards. Since the Gulf War, several other large deployments have also occurred, including deployments to Haiti and Somalia. Major deployments to Bosnia, Southwest Asia, and, most recently, Kosovo are ongoing as this report is written. This report draws on lessons learned from some of these deployments to consider strategies to protect the health of troops in future deployments. In the spring of 1996, Deputy Secretary of Defense John White met with leadership of the National Research Council and the Institute of Medicine to explore the prospect of an independent, proactive effort to learn from lessons of the Gulf War and to develop a strategy to better protect the health of troops in future deployments.

Strategies to Protect the Health of Deployed U.S. Forces
Copyright
REVIEWERS
Preface
Acronyms
Contents
Executive Summary
- MEDICALLY UNEXPLAINED SYMPTOMS
  - Recommendations
- MEDICAL SURVEILLANCE
  - Recommendation
  - Recommendations (Additional Recommendations are in Chapter 4)
  - Recommendations
- POSTDEPLOYMENT REINTEGRATION
  - Recommendations
- MEDICAL RECORD KEEPING
  - Recommendations (Additional Recommendations are in Chapter 5)
  - Recommendations
  - Recommendation
- RISK COMMUNICATION
  - Recommendation
- RESERVES
  - Recommendation
- CONCLUSIONS
1 Introduction
- EMPHASIS AND IMPLICIT ASSUMPTIONS
- RELATED EFFORTS
- STUDY PROCESS AND INFORMATION SOURCES
- THE FUTURE MILITARY
2 Risks to Deployed Forces
- INFECTIOUS DISEASES
- NON-BATTLE INJURIES
  - Heat and Cold Injuries
- PSYCHOLOGICAL STRESS
- TOXIC INDUSTRIAL CHEMICALS
- CHEMICAL WEAPONS
- BIOLOGICAL WEAPONS
- PROTECTIVE MEDICATIONS
- INTERACTIONS
3 Medically Unexplained Symptoms
- EPIDEMIOLOGY
- PREDISPOSING FACTORS
  - Physiological Differences and Susceptibilities
  - Early Life Adversity
  - Chronic Medical Illness
- PRECIPITATING FACTORS
- PERPETUATING FACTORS
- PROGNOSTIC INDICATORS
4 Medical Surveillance
- DOD POLICIES ON MEDICAL SURVEILLANCE
  - Force Health Protection
  - DoD Joint Directive
  - DoD Joint Instruction
  - DoD Joint Memorandum on Deployment Health Surveillance and Readiness
  - Joint Publication 4-02 Doctrine for Joint Health Service Support
  - National Science and Technology Council, Presidential Review Directive 5
- CURRENT SERVICE PRACTICES AND PLANS
  - Garrison
    - Recruit Assessment Program
    - Periodic Health Assessments
    - Periodic Blood Draw
    - Surveillance for Drug-and Vaccine-Associated Adverse Events
    - Laboratory-Based Surveillance
    - Defense Medical Surveillance System
    - Global Surveillance for Infectious Disease Threats to Military Operations — Role of Overseas Medical Laboratories
  - Deployment
    - Pre-and Postdeployment Questionnaires
    - Capture of Ambulatory Care and Inpatient Data During Deployments
    - Theater Medical Information Program
    - Identifying Deployed Populations
    - Deployment Exposure Data
  - Postdeployment Medical Surveillance
    - Immediate Postdeployment Surveillance
    - Routine Postdeployment Surveillance
    - Deployment-Related Registries
    - Long-Term Surveillance
    - Reproductive Outcomes
  - Confidentiality of Health Information
- FINDINGS AND RECOMMENDATIONS
5 Medical Record Keeping
- INFORMATION NEEDS OF THE MILITARY HEALTH SYSTEM
  - Individual Care
  - Preventive Care
  - Medical Surveillance
  - Databases for Epidemiologic Studies
  - Longitudinal Record Keeping
- MAJOR INFORMATION SYSTEMS ACTIVITIES
  - Composite Health Care System
  - Government Computer-Based Patient Record Project
  - Health Assessment Instruments
    - Preventive Health Care Application
    - Pre-and Postdeployment Questionnaires
    - Recruit Assessment Program
  - Deployment Medical Surveillance System
  - Personal Information Carrier
- INFORMATION SYSTEMS ACQUISITION AND DEVELOPMENT PROCESS
- CONFIDENTIALITY OF HEALTH INFORMATION
- SUMMARY
- FINDINGS AND RECOMMENDATIONS
6 Prevention Measures for Deployed Forces
- RISK COMMUNICATION
- PREVENTIVE MEASURES BEFORE DEPLOYMENT
  - Preventive Measures on Entrance into the Service
    - Risk Communication
    - Accession Standards
    - Retention Standards
    - Recruit Assessment Plan
  - Preventive Measures During Training and Routine Garrison Life
    - Doctrine
    - Training
  - Vaccines
    - Policy
    - Vaccine Acquisition and Supply
    - Identification of Biological Warfare Threats
    - Vaccine Coverage
    - Immunization Record Keeping
    - Anthrax Vaccine
  - Preventive Measures Immediately Before Deployment
- PREVENTIVE MEASURES DURING DEPLOYMENT
  - Risk Communication
  - Combat Stress Reactions and Control
  - Use of Investigational New Drugs by the Armed Forces
- PREVENTIVE MEASURES AFTER DEPLOYMENT
  - Risk Communication
  - Reintegration
  - Medical Management and Symptomatic Treatment of Medically Unexplained Symptoms
- FINDINGS AND RECOMMENDATIONS
7 Postdeployment Reintegration
- INTRODUCTION
  - Family-and Work-Related Problems of Deployment
  - Effects of Downsizing and Increased Operational Tempo
- MILITARY REUNION AND REINTEGRATION LITERATURE REVIEW
  - Information Gathering
  - Family Factors
  - Reunion Period
    - Return Phase
    - Readjustment Phase
    - Reintegration Phase
  - Return of the Wounded or Ill
  - Role of Family in Readjustment
  - Family Roles in Readjustment in Non-Military Settings
  - Prevention of War-Related Stress for Family Members
- PROGRAMS TO ASSIST FAMILIES AND SERVICE MEMBERS WITH REINTEGRATION
  - Navy Support Services
  - Army Support Services
  - Air Force Support Services
  - Programs to Help Support National Guard and Reserves
  - VA Support Programs
- FINDINGS AND RECOMMENDATIONS
8 Protecting the Health of the Reserve Component
- DEMOGRAPHICS AND HEALTH ISSUES
  - Categories of Reserve Forces
  - Demographics
  - Deployments of Reserve Forces
  - Health Problems in Reserves
- UNIQUE CIRCUMSTANCES
- IMPLEMENTATION OF REPORT RECOMMENDATIONS
  - Medical Surveillance
  - Medical Record Keeping
  - Preventive Measures
  - Reintegration
- FINDINGS AND RECOMMENDATIONS
References
APPENDIX A Population and Need-Based Prevention of Unexplained Physical Symptoms in the Community
- SYNOPSIS
- UNDERSTANDING MEDICALLY UNEXPLAINED PHYSICAL SYMPTOMS
- EPIDEMIOLOGY OF SYMPTOMS AND SYMPTOM-BASED DISORDERS
  - Prevalence in the Community and Primary Care
  - Natural History of MUPS
  - Prognostic Factors: Prediction of Outcomes and Assessment of Future Needs
- PREVENTION OF SYMPTOMS AND SYMPTOM-BASED DISORDERS
  - Advantages of Population-Based Intervention
  - Advantages of Need-Based Intervention
  - Population-Based Care: Matching Resources to Needs
  - Implementing and Improving Population-Based Care
    - Information Systems
    - Practice Design
    - Patient Education and Clinical Risk Communication
  - Stepped-Care Approach to Population MUPS Management
    - Step One: Preevent Primary Prevention
    - Step Two: Postevent Primary Prevention
    - Step Three: Routine Primary Care
      - Routine Primary Care Physician Management
      - Teaching MUPS Management to Primary Care Physicians
    - Step Four: Collaborative Interventions in Primary Care
    - Step Five: Specialized Intensive Multimodal Care
      - Components of Specialized Services
      - Obstacles to Specialized Services
- CONCLUSIONS
- REFERENCES
APPENDIX B Statement of Task
APPENDIX C Roster and Biographies of Study Team
- PRINCIPAL INVESTIGATORS
- ADVISORS
- BIOGRAPHIES
  - Principal Investigators
  - Advisors
APPENDIX D Principal Investigators' and Advisors' Meeting Dates and Locations
APPENDIX E Workshop Agendas
Appendix F Commissioned Papers
APPENDIX G Acknowledgments
APPENDIX H Department of Defense Directive 6490.2: Joint Medical Surveillance
APPENDIX I Department of Defense Instruction 6490.3 Implementation and Application of Joint Medical Surveillance for…
APPENDIX J Joint Chiefs of Staff Memorandum on Deployment Health Surveillance and Readiness, December 1998