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					DoD Health from the Battlefield




              Michael E. Kilpatrick, M.D.
Deputy Director, Deployment Health Support Directorate
                    26 August 2006
DoD Force Health Protection
 Providing a Full Continuum of Care




                                      2
       DoD Health Surveillance Continuum
                Service Member Health Assessments


Force Health Protection                                     Retirement/
                                                           Separation &
                                                              Beyond
                            Transit


             Operation
                                          Pre-Deployment


       Re-Deployment

                                      Annual Preventive
                                      Health Assessment
                       Post-          or Sep/Retirement
                    Deployment
                   Reassessment
 Accession                                  Population Health
                                                                          3
              Total Service Members Ever
                  Deployed, OEF/OIF

Length of Deployment    Unique Service Members


<14 days                                  7,450


15-30 days                                27,845


31 days or longer                       1,303,915


Total                                   1,339,210

                         Source: DMDC CTS Deployment File, as of 30 Jun 06

                                                                         4
         Operational Medicine Big Picture
                        As of 25 July 2006

• 19,994 servicemembers have been wounded in
  action
   • 10,704 wounded in action have returned to duty within
     72 hours. 9,290 have not.
• 34,395 servicemembers have been medically
  transported from theater
   • 59% are evacuated due to disease
   • 22% are evacuated due to non-battle injury
   • 19% are evacuated due to battle injury (aka wounded
     in action
• There are 6,648 servicemembers on medical hold
   • On average 83% are returned to the force
   • On average 17% are medically separated

                                                             5
      Medical Air Transports of Individual
               Servicemembers
70%       59%
                                 Disease
60%
                                 Non-Battle Injury
50%
                                 Battle Injury
40%
                                       Data Source:
30%
                                     USTRANSCOM
                 22%    19%
                                         TRAC2ES
20%
                                   As of 24 July 2006
10%

0%

From 2001-2006, the total MATs
of individual servicemembers
= 34,395
                                                        6
        Disease & Non-Battle Injuries (DNBI)
                   CENTCOM (OEF/OIF) Combined

• Overall rate – 4% per week
  • Injuries, all types   25%
           –   Training/Work 44%
           –   Sports         16%
           –   Heat/Cold       3%
           –   Motor Vehicles 2%
           –   Other          35%
  •   Respiratory                   13%
  •   Dermatologic                  12%
  •   Gastrointestinal               7%
  •   Mental Health                  3%
  •   Combat Stress                  2%
  •   All other categories          38%
                                                                      Data Source:
                                          Air Force Institute of Operational Health
                                                                  As of 15 Jul 2006
                                                                                  7
             DoD AMPUTEES in OEF and OIF

•   712 Total Amputations as of 12 July 2006
•   Most Common Causes
     1. IED (42%)
     2. Accident (9%)
     3. Blast (8%)
     4. Rocket propelled grenade (8%)
     5. Gunshot wound (6%)
•   Outcome/Disposition
     1. As of 19 Apr 06, 195 Servicemembers with limb loss had completed
        MEB/PEB with 34 (17%) able to continue in military service
     2. 25 of 34 returned to their original career field


                                                                           8
                             Traumatic Brain Injury
        TBI Injury Mechanism                 TBI Severity of Injury
     TBI Injury Mechanism                     TBI Severity of Injury
                 Vehicular                                   Unknown
                   13%                                         1%
                                               Penetrating
         Other                                     5%
          4%                                Severe
                                             13%
Fragment
  11%
    Fall                                  Moderate
                                  Blast
    6%                                      17%                            Mild
                                  62%
                                                                           64%
           Bullet
            4%

 • Spectrum of TBI range from mild to severe, grand total=1,299
        – Most (822 or 64%) are mild
 • Operational breakout, OIF (96%), OEF (4%)
            Data from Defense Veterans Brain Injury Center, as of May 06
                                                                                  9
               Status of OEF/OIF Deployment Occupational &
                      Environmental Health Monitoring

• From Jan 1, 2003 to December 31, 2005: Nearly
   4,000 samples (Army – some AF and Navy) analyzed
   at USACHPPM for > 350,000 parameters
                                   Overall Risk
            # of Sites     # of    of Possible
 Media                                                                Comments
            Sampled      Samples      Health
                                     Effects
                                                  Sand and dust exceed guidelines. Minimal acute
   Air         209        2580                    health risks; long-term effects not known
                                    Moderate
 Water                                            Moderate health risk, but in most cases would
               204         332      Moderate      require consumption of a water source for
Treated                                           prolonged periods of time
 Water                                            Minimal health risk because untreated water is most
               98          152                    likely not consumed by US Forces
Untreated                            Minimal
                                                  Contaminants are unlikely to result in high enough
  Soil         252         853                    exposures to cause adverse health effects
                                     Minimal
   > 14,000 samples analyzed in theater                                                                10
         Distribution of Self-reported General Health
       Status: Pre-Deployment/Post-Deployment/Post-
                 Deployment Re-assessment
               Pre-Deployment    Post-Deployment          Post-Deployment Re-assessment


       45.0%

       40.0%

       35.0%

       30.0%

       25.0%

       20.0%

       15.0%

       10.0%

        5.0%

        0.0%
                  Excellent     Very good          Good              Fair             Poor


DMSS Data July 2006
                                                                                     n=75,619
                                                                                                11
                      Post-deployment Health Assessment Key
                         Results January 1, 2006 – July 24, 2006

                       Health                                                           Referral
                                            Medical/     Currently      Mental
                     (Excellent,                                                       Indicated
                                             Dental      on Profile     Health
                     Very Good,                                                         for any
                                            Problems                   Concerns
                       Good)                                                            reason

Active Duty
                         92%                  22%           7%               5%          18%
(N=89,336)
Reserve
Components               91%                  42%          11%               7%          26%
(N=40,830)


  NOTE: Service members’ responses on                       Most common reasons for referral:
 DD Forms 2796 submitted since 01 Jan 06,
       all operations/deployments.                         - Dental (annual exam, cleaning,
                                                           caries)
Data Source: Defense Medical Surveillance System, Army
Medical Surveillance Activity                              - Musculoskeletal (orthopedics)
As of 24 July 2006                                         - Mental health



                                                                                                   12
             Post-deployment Health Re-Assessment Key Results
                      September 1, 2005 – July 11, 2006


                        Health                           Environ-                    Referral
                                          Medical/                    Mental
                      (Excellent,                         mental                    Indicated
                                           Dental                     Health
                      Very Good,                         Concerns                    for any
                                          Concerns                   Concerns
                        Good)                                                        reason

Active Duty
(N=62,613)
                         87%                48%           17%             31%            21%

Reserve
Components               77%                73%           43%             52%            54%
(N=12,973)


   NOTE: Service members’ responses on                   Most common concerns reported:
   DD Forms 2900 submitted since 01 Sep
      05, all operations/deployments.
                                                            - Sleep / fatigue problems
Data Source: Defense Medical Surveillance System, Army      - Back pain
Medical Surveillance Activity
As of 11 July 2006




                                                                                                13
                        Mental Health


Goals
• Early education, early intervention, access to care

Result
• More than 35% of our servicemembers are coming into
  mental health clinics for consultation
• Only about a third of those members come away with an
  actual diagnosed mental health condition.




                                                          14
         Criteria for Post Traumatic Stress
                       Disorder


1. Death/Injury-threatening trauma causing intense fear,
   hopelessness, horror
2. Re-Experiencing symptoms
3. Persistent Avoidance of trauma-associated stimuli
4. Increased arousal
5. Symptoms last longer than a month
6. Functionally impaired


                                                           15
                 VA Healthcare Utilization
                            2002 - 2QTR 2006

• 555,478 OIF and OEF veterans have left active duty
  and become eligible for VA health care since FY02
   – 43% (239,177) are former Active Duty troops
   – 57% (316,301) are Reserve and National Guard troops
• Among all 555,478 separated OIF/OEF Veterans
   – 30% (168,421) have sought VA health care since FY02
        • 34% (80,968) are former Active Duty troops
        • 28% (87,453) are Reserve and National Guard troops
        • 3% (4,925) of 168,421 evaluated OIF/OEF patients have
          been hospitalized at least once in a VA health care facility



                                                                         16
              Annual Health Assessments
         Periodic/Preventive Health Assessment (PHA)



• Replaces outmoded every 5-yr physical with tailored
  annual assessment
   – Self-report using Health Assessment Review Tool (HART)-R/F/P
   – Review medical records and DD Form 2766
   – Review all IMR requirements, correct gaps
• Identify personal health risks (occupational, lifestyle,
  etc.), educate, and provide a blueprint for improved
  health (manage &/or prevent)




                                                                    17
                         Resources
Military One Source (800) 342-9647 www.militaryonesource.com
Military Severely Injured Center (800) 774-1361
         severelyinjured@militaryonesource.com
Army Wounded Warrior Program (800) 833-6622 www.armyds3.org
Marine for Life (866) 645-8762 injuredsupport@M4L.usmc.mil
Air Force Palace HART (888) 774-1361
        severelyinjured@militaryonesource.com
Navy Safe Harbor (888) 774-1361 severelyinjured@militaryonesource.com
DHSD Deployment Helpline (800) 497-6261
Deployment Health Clinical Center http://www.pdhealth.mil
DeploymentLINK http://deploymentlink.osd.mil
Deployment Health and Family Readiness Library
       http://deploymenthealthlibrary.fhp.osd.mil
                                                                        18
                    Contact Information

• DHSD Veterans’ Helpline - (800) 497-6261


• E-mail -
  special.assistant@deploymenthealth.osd.mil

• GulfLINK - http://www.gulflink.osd.mil


• DeploymentLINK - http://deploymentlink.osd.mil


• Michael.Kilpatrick@deploymenthealth.osd.mil


                                                   19

				
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