Strategies to protect the health of deployed U.S. forces : medical surveillance, record keeping, and risk reduction / Lois M. Joellenbeck, Philip K. Russell, and Samuel B. Guze, editors.

Format:

Book

Contributor:

Joellenbeck, Lois M. (Lois Mary), 1963-

Russell, Philip K.

Guze, Samuel B., 1923-

Institute of Medicine (U.S.). Medical Follow-up Agency.

Series:

Compass series (Washington, D.C.)

The compass series

Language:

English

Subjects (All):

Soldiers--Health and hygiene--United States.

Soldiers.

Soldiers--Protection--United States.

Soldiers--Health risk assessment--United States.

Persian Gulf War, 1991--Health aspects.

Persian Gulf War, 1991.

United States--Armed Forces--Sanitary affairs.

United States.

United States--Armed Forces--Medical care.

Physical Description:

1 online resource (296 p.)

Edition:

1st ed.

Place of Publication:

Washington, DC : National Academy Press, c1999.

Language Note:

English

Summary:

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.

Contents:

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)

POSTDEPLOYMENT REINTEGRATION

MEDICAL RECORD KEEPING

Recommendations (Additional Recommendations are in Chapter 5)

RISK COMMUNICATION

RESERVES

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

Deployment Medical Surveillance System

Personal Information Carrier

INFORMATION SYSTEMS ACQUISITION AND DEVELOPMENT PROCESS

CONFIDENTIALITY OF HEALTH INFORMATION

SUMMARY

6 Prevention Measures for Deployed Forces

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

Combat Stress Reactions and Control

Use of Investigational New Drugs by the Armed Forces

PREVENTIVE MEASURES AFTER DEPLOYMENT

Reintegration

Medical Management and Symptomatic Treatment of Medically Unexplained Symptoms

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

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 Record Keeping

Preventive Measures

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

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.

Notes:

"Medical Follow-up Agency, Institute of Medicine."

Includes bibliographical references (p. 147-171).

ISBN:

9786610185757

9780309172523

0309172527

9781280185755

1280185759

9780309571401

0309571405

9780585182391

0585182396

OCLC:

44963849