dod health from the battlefield michael e. kilpatrick, m.d. deputy director, deployment health...

DoD Health from the Battlefield

Michael E. Kilpatrick, M.D.Deputy Director, Deployment Health Support Directorate

26 August 2006

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DoD Force Health Protection Providing a Full Continuum of Care

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DoD Health Surveillance Continuum Service Member Health Assessments

Retirement/

Separation &

Beyond

Post-Deployment Reassessment

Transit

Force Health ProtectionForce Health Protection

Annual Preventive Health Assessment or Sep/Retirement

Re-Deployment

OperationPre-Deployment

Deployed

In Garrison

Accession Population HealthPopulation Health

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Total Service Members Ever Deployed, OEF/OIF

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

1,339,210Total

1,303,91531 days or longer

27,84515-30 days

7,450<14 days

Unique Service MembersLength of Deployment

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• 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

Operational Medicine Big Picture As of 25 July 2006

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59%

22% 19%

0%

10%

20%

30%

40%

50%

60%

70%Disease

Non-Battle Injury

Battle Injury

From 2001-2006, the total MATs of individual servicemembers = 34,395

Data Source: USTRANSCOM

TRAC2ES

As of 24 July 2006

Medical Air Transports of Individual Servicemembers

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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

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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

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Traumatic Brain Injury

• 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

TBI Injury Mechanism TBI Severity of Injury

11%

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• From Jan 1, 2003 to December 31, 2005: Nearly 4,000 samples (Army – some AF and Navy) analyzed at USACHPPM for > 350,000 parameters

Minimal health risk because untreated water is most likely not consumed by US ForcesMinimal

15298Water

Untreated

853

332

2580

# of Samples

Comments

252

204

209

# of Sites Sampled

Overall Risk of Possible

Health Effects

Sand and dust exceed guidelines. Minimal acute health risks; long-term effects not knownModerate

Air

Moderate health risk, but in most cases would require consumption of a water source for prolonged periods of time

ModerateWater

Treated

Media

Contaminants are unlikely to result in high enough exposures to cause adverse health effectsMinimal

Soil

Status of OEF/OIF Deployment Occupational & Environmental Health Monitoring

> 14,000 samples analyzed in theater

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0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

30.0%

35.0%

40.0%

45.0%

Excellent Very good Good Fair Poor

n=75,619

Pre-Deployment Post-Deployment Post-Deployment Re-assessment

Distribution of Self-reported General Health Status: Pre-Deployment/Post-Deployment/Post-

Deployment Re-assessment

DMSS Data July 2006

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Post-deployment Health Assessment Key Results January 1, 2006 – July 24, 2006

Medical/ Dental

Problems

Health

(Excellent, Very Good,

Good)

Currently on Profile

Mental Health

Concerns

Referral Indicated for any reason

Active Duty

(N=89,336)

Reserve Components(N=40,830)

92% 22% 7% 5% 18%

91% 42% 11% 7% 26%

NOTE: Service members’ responses on DD Forms 2796 submitted since 01 Jan 06,

all operations/deployments.

Data Source: Defense Medical Surveillance System, Army Medical Surveillance Activity

As of 24 July 2006

Most common reasons for referral:

- Dental (annual exam, cleaning, caries)

- Musculoskeletal (orthopedics)

- Mental health

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

Medical/ Dental

Concerns

Health

(Excellent, Very Good,

Good)

Environ-mental

Concerns

Mental Health

Concerns

Referral Indicated for any reason

Active Duty (N=62,613)

Reserve Components (N=12,973)

87% 48% 17% 31% 21%

77% 73% 43% 52% 54%

NOTE: Service members’ responses on DD Forms 2900 submitted since 01 Sep

05, all operations/deployments.

Data Source: Defense Medical Surveillance System, Army Medical Surveillance Activity

As of 11 July 2006

Most common concerns reported:

- Sleep / fatigue problems

- Back pain

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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.

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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

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• 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

VA Healthcare Utilization2002 - 2QTR 2006

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Annual Health AssessmentsPeriodic/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)

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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

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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