Protecting Those Who Serve Strategies to Protect the Health of Deployed U.S. Forces (2000) / Chapter Skim
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Appendix E: Strategies to Protect the Health of Deployed U.S. Forces: Medical Surveillance, Record Keeping, and Risk Reduction--Executive Summary
Appendix E: Strategies to Protect the Health of Deployed U.S. Forces: Medical Surveillance, Record Keeping, and Risk Reduction--Executive Summary
Pages 83-96
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From page 83... ...
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.
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From page 84... ...
The study presented here, carried out with staff support from the Medical Follow-up Agency of the Institute of Medicine, addresses the topics of medical protection, health consequences and treatment, and medical record keeping. The study team was charged with addressing the following: · Prevention of adverse health outcomes that could result from exposures to threats and risks including chemical warfare and biological warfare, infectious disease, psychological stress, heat and cold injuries, unintentional injuries, · Requirements for compliance with active duty retention standards, · Predeployment screening, physical evaluation, and risk education for troops and medical personnel, · Vaccines and other prophylactic agents, · Improvements in risk communication with military personnel in order to minimize stress casualties among exposed or potentially exposed personnel, · Improvements in the reintegration of all troops to the home environment, · Treatment of the health consequences of prevention failures, including battle injuries, disease and non-battle injury (DNBI)
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From page 85... ...
These three topics of medically unexplained symptoms, medical surveillance, and medical record keeping form the critical areas of emphasis of the report. Although the study team considered the service member's life cycle of recruitment, predeployment, deployment, and postdeployment to include separation from the service, the postdeployment period appeared to be a time when, in particular, additional effort could be crucial in attending to the health of the deployed forces.
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From page 86... ...
Taking those efforts into account, with this report the study team proposes additional and complementary strategies to more effectively address medically unexplained symptoms, medical surveillance, and medical record keeping for future deployments, as well as other aspects of prevention such as risk communication and reintegration. The report emphasizes the need to extend medical surveillance and record keeping and other protections to the reserve components.
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From page 87... ...
Recommendations The study team recommends that the U.S. Department of Defense develop an improved strategy to address medically unexplained symptoms, involving education, detection, evaluation, mitigation, and research.
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From page 88... ...
· Treat medically unexplained symptoms in the primary care setting whenever possible, with referral to more intensive programs as necessary. · Carry out a research program with prospective studies to assess the role of predisposing, precipitating, and perpetuating factors in medically unexplained symptoms.
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From page 89... ...
· Annually administer an improved Health Evaluation and Assessment Review (HEAR) to reserve as well as to active-duty personnel to obtain baseline health information.
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From page 90... ...
to a representative sample of service members who have been separated from the service for 2 to 5 years after a major deployment to track health status and identify health concerns including medically unexplained symptoms. Also administer the HEAR to those separated service members who seek health care during the 2 years after a deployment.
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From page 91... ...
MEDICAL RECORD KEEPING Previous studies have cited deficiencies in medical record keeping as a major impediment to understanding and treating the health effects associated with deployment to the Gulf War (Institute of Medicine, 1996a, Presidential Advisory Committee on Gulf War Veterans' Illnesses, 1996b)
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From page 92... ...
To the extent possible, the needs of all three services should be considered concurrently to maximize the reuse of data and software programs. In addition to the development of technical plans for data integration, organizational plans need to be developed to standardize policies and practices related to medical record keeping.
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From page 93... ...
forces deployed abroad, however, a unified CPR system is essential. The study team recommends that a comprehensive review of the military health information systems strategy be undertaken to enumerate the information needs, define an expedient process for development of an enterprisewide technical architecture, common data model, and data standards, identify critical dependencies, establish realistic time lines, assess the adequacy of resources, and perform a realistic risk assessment with contingency plans.
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From page 94... ...
The risk communication efforts associated with the vaccination against anthrax, the risk communication goal articulated in Presidential Review Directive 5, the guide developed in response to recommendations from earlier independent advisory bodies, and the Comprehensive Risk Communication Plan for Galf War Veterans (Persian Gulf Veterans Coordinating Board, 1999) are encouraging signs that the importance of risk communication has been acknowledged within some quarters at DoD.
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From page 95... ...
RESERVES 95 Several of the most important components of a strategy to protect the health of deployed forces (improved medical surveillance and care that is responsive to medically unexplained symptoms, record keeping, risk communication, the use of preventive measures, and reintegration into the home environment) pose particular challenges for the reserve component because of their quasicivilian status and geographically dispersed situation.
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From page 96... ...
The medically unexplained symptoms reported by veterans after the Gulf War have motivated many of DoD's constructive changes in medical surveillance and medical record keeping, but these initiatives cannot be anticipated to prevent them after future deployments. Indeed, it is not yet known how medically unexplained symptoms can be prevented.
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