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Deployment Health Report – April 2008Emphasis on OIF, OEF
Organization• Casualty Summary - Deaths and Injuries• Severely Injured
– Traumatic Brain Injuries– Amputees
• Disease and Non-battle Injuries (DNBI)• Medical Air Transports from CENTCOM• Post-deployment Health Assessment and Re-Assessment• Medical Holding• Conditions Found in Medical Evaluation Boards• Surveys of Ill / Injured Service Members Post Deployment
2
• Of those wounded in action, approximately 70% (OIF) and 43% (OEF) remain in theater, i.e., do not require Medical Air Transport.
• Of those wounded in action, approximately 55% (OIF) and 39% (OEF) return to duty within 72 hours.
Source: Defense Manpower Data Center, Statistical Information Analysis Division
Total Deaths – 4,511
Total WIA – 31,707
(as of April 12, 2008)
3Source: Defense Veterans Brain Injury Center as of February 29, 2008
TRAUMATIC BRAIN INJURIES
Agent of Injury Severity of Injury
4
Percent of Amputees, by Service Circumstances of Injury
AMPUTEES – OEF AND OIF(N = 1,056)
Source: US Army OTSG, as of 1 March 2008
5
Disease & Non-Battle Injuries (D & I) in TheaterCENTCOM (OEF/OIF) Combined
Percent of all Encounters
Data Source: JMeWS 01JAN05 to 07APR08
Army NavyMarine Corps
Air Force
Total
Combat Stress 1% 1% 1% 1% 1%
Dermatologic 10% 11% 11% 13% 11%
GI 4% 3% 3% 5% 4%
Injuries, all causes 30% 24% 30% 19% 29%
Other 39% 45% 42% 41% 40%
Psych Mental 6% 5% 5% 6% 6%
Respiratory 9% 11% 7% 15% 10%
Total Encounters 785,237 44,551 18,247 112,671 960,706
6
Injury Distribution in TheaterCENTCOM (OEF/OIF) CombinedPercent of all Injury Encounters
Data Source: JMeWS 01JAN05 to 07APR08
Army NavyMarine Corps
Air Force
Total
Injuries, all causes 30% 24% 30% 19% 29%
Injury Heat/Cold 1% 1% 1% 1% 1%
Injury MVA 1% 1% 2% 1% 1%
Injury Other 18% 21% 19% 31% 19%
Injury Sports 28% 33% 24% 28% 28%
Injury Work 51% 44% 54% 40% 50%
Total Encounters 239,357 10,867 5,502 21,170 276,896
7
Medical Air Transports from CENTCOM for OEF/OIF
Total # of Service Members Transported: 48,904
Distribution by Underlying Condition:• Disease 58%• Non-Battle Injury 21%• Battle Injury 21%
Data Source: USTRANSCOM TRAC2ES
As of 15 April 2008
8
0%
10%
20%
30%
40%
50%
60%
70%
80%
2001 2002 2003 2004 2005 2006 2007 2008
% A
mo
ng
SM
s M
edic
ally
Air
Tra
nsp
ort
ed
1Battle Inj 2NonBI 3Disease
% Distribution, by Year, of Disease, Non-Battle Injuries, and Combat Injuries Among Service Members Medically Air Transported from
CENTCOM
Data Source: USTRANSCOM TRAC2ES
As of 15 April 2008
9
GWOT Medical Air Transports (MAT)
Individual Service MembersTransported from CENTCOM to Elsewhereas of 15 April 2008, source: TRAC2ES
OIF - MATs (since 19March2003) TOTAL USA USN USMC USAF USCGBI - Battle Injury MATs 9,068 6,818 163 1,997 88 2 NBI - Non Battle Injury MATs 8,470 6,714 296 1,102 352 6 Dz - Disease MATs 23,597 20,159 754 1,583 1,091 10 TOTAL - OIF Medical Air Transports 41,135 33,691 1,213 4,682 1,531 18
OEF - MATs since 07October2001) TOTAL USA USN USMC USAF USCGBI - Battle Injury MATs 1,083 942 13 90 38 0 NBI - Non Battle Injury MATs 1,748 1,263 98 138 249 0 Dz - Disease MATs 4,938 3,787 207 213 729 2 TOTAL - OEF Medical Air Transports 7,769 5,992 318 441 1,016 2
GLOBAL WAR ON TERRORISM - TRAC2ES - Medical Air Transports (MATs)
Data Source: USTRANSCOM TRAC2ES
As of 15 April 2008
10
MATs from OEF / OIF for DiseaseMilitary Personnel
Most Frequent Major Diagnostic Categories
Data Source: USTRANSCOM TRAC2ES
As of 15 April 2008
11
MATs from OEF / OIF for DiseaseCivilians and Contractors
Most Frequent Major Diagnostic Categories
Data Source: USTRANSCOM TRAC2ES
As of 15 April 2008
12
Musculoskeletal System / Connective Tissue
Disorders of the vertebral column 2,664
Miscellaneous soft tissue disorders 1,327
Non-arthritic joint disorders 894
Arthritis of the joints of the arms and legs 54
All other conditions 403
TOTAL 5,342
MAT from OEF and OIF for DiseaseMilitary Personnel Only
Details about Major Diagnostic Categories (selected)
Data Source: USTRANSCOM TRAC2ES
As of 15 April 2008
13
MAT from OEF and OIF for DiseaseMilitary Personnel Only
Details about Major Diagnostic Categories (selected)
Symptoms, Signs, and Other Ill-Defined Conditions
Symptoms related to the respiratory system and chest 1,176(Chest pain, Dyspnea, Cough, Hemoptysis, Stridor)
Alterations of consciousness 847 (Convulsions, Syncope and collapse, Alteration of consciousness,
Dizziness and giddiness, Hallucinations)
Abdominal pain 413
Sleep disturbances 210
Headache 188
All other conditions 1,551(e.g., Swelling or mass or lump in head and neck, Palpitations, Enlargement
of lymph nodes, Dysphagia, Abdominal or pelvic swelling, mass or lump)
TOTAL 4,389
Data Source: USTRANSCOM TRAC2ES
As of 15 April 2008
14
Mental Disorders
Depression and depressive disorders 1,044
Adjustment disorders (incl. PTSD) 677
Neurotic disorders 419
Manic and bipolar disorders 292
Organic mental disorders 246
Personality disorders 217
Acute stress reactions 141
Schizophrenia 66
All other conditions 396
TOTAL 3,498
MAT from OEF and OIF for DiseaseMilitary Personnel Only
Details about Major Diagnostic Categories (selected)
Data Source: USTRANSCOM TRAC2ES
As of 15 April 2008
15
12 Most Common Types of “Disease” Resulting in MAT
Military Personnel Only No. of MAT % of all for This Disease Category MATs
Disorders of the vertebral column 2,664 9.2%Misc. soft tissue disorders of the musculoskeletal system 1,327 4.6%Ill-defined symptoms related to resp. system and chest 1,176 4.0%Inguinal & abdominal hernias 1,054 3.6%Depression and depressive disorders 1,044 3.6%Non-arthritic disorders of joints 894 3.1%Ill-defined alterations of consciousness 847 2.9%Skin disorders 739 2.5%Adjustment disorders, including PTSD 677 2.3%Urinary stones (calculi) 543 1.9%Breast Disorders 435 1.5%Appendicitis 432 1.5%Coronary artery disease 423 1.5%TOTAL OF THESE 13 CATEGORIES 12,255 42.9%
TOTAL OF ALL DISEASE MATS 28,535
Data Source: USTRANSCOM TRAC2ES
As of 15 April 2008
16*2% of individuals do not respond to this question, so the total is less than 100%♦ Any positive response to Questions 11-13 on DD Form 2796 or Questions 8, 9, or 11 on DD Form 2900
Pre-DHA
(DD 2795)
Post-DHA
(DD 2796)
Post-DHRA
(DD 2900)
# Completed (# of Individuals) 105,317 78,136 102,278
Self-reported HealthExcellent, Very Good, Good
Fair, Poor
97%
3%
94%
6% 84%*
15%*
Physical Concerns 10% 24% 40%
Mental Health Concerns n/a 33% ♦ 43% ♦
Exposure Concerns n/a 17% 27%
Referred for Further Evaluation 5% 23% 27%
When Assessment is Completed Within 60 days of expected deployment
Within 30 days of return home
3 – 6 months after return
Pre- and Post-Deployment Health Assessments and Post-Deployment Health Re-assessments (PDHRA)
1 January 2008 – 17 April 2008
17
Recovering Service Member OverviewTotal force, not just GWOT related
Source: Services
18
Recovering Service Member Overview Total Force, not just GWOT-related
Source: Services SGs: As of April 1, 2008
19
Medical Evaluation Boards (MEB)Most Common Major Categories of Primary Diagnoses Among
3,825 Army Personnel Completing MEBs (1 Sep 07 – 20 Mar 08) No. of Soldiers % of Total Musculoskeletal System 2,100 55% Lower back pain 453 Degenerative disc dis 310
Knee pain 294 Foot, ankle pain 140 Shoulder pain 116
Mental Disorders 584 15% PTSD 302 Bipolar disorder 64
Anxiety disorder 61 Depression 53
Injury and Poisoning 280 7% Traumatic brain injury 44
Nervous System and Sense Organs 193 5% Respiratory System 125 3% Asthma 110 Endocrine, Metabolic Conditions 124 3%
Diabetes mellitus 117 Symptoms, Signs, Ill-Defined Conditions 116 3% Sleep apnea 43 All 13 Other Major Categories 303 8%
(Includes all Soldiers, not just OEF/OIF veterans)
20
Telephone Survey of Ill and Injured Service Members
Post-Operational DeploymentAfter Ten Months
March 27, 2008
Rich Bannick, Ph.D.OASD(HA)/TMA,
Health Program Analysis & Evaluation Division
21
MEB
PEB*Manage duties
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
May 07(n=154
234)
Jun 07(n=10-241)
Jul 07(n=2-104)
Aug 07(n=4-78)
Sep 07(n=5-104)
Oct 07(n=4-87)
Nov 07(n=15-173)
Dec 07(n=6-156)
Jan 08(n=56-123)
Feb 08(n=1-104)
% R
ati
ng
1
or
2
Health care Lodging
Basic needs Medical attendees
Medical Evaluation Board (MEB) Physical Evaluation Board (PEB)*
Manage duties
Surveyed Service Members’ Ratings in Areas Related to Their Medical Hold / Holdover Experience
(Points on Graph Reflect the Percentage of Participants in the Month Shown Who Responded with a Rating of “1” or “2” on the 5-point scale)
1 2 3 4 5Poor Outstanding
PreferredDirection
* Small PEB numbers
PEB: n=1
22
Getting urgent care as soon as needed
Getting an appointment as soon as needed
Getting treatment or counseling
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
May 07(n=53-245)
Jun 07(n=58-263)
Jul 07(n=29-141)
Aug 07(n=12-129)
Sep 07(n=18-136)
Oct 07(n=14-133)
Nov 07(n=37-185)
Dec 07(n=24-131)
Jan 08(n=17-100)
Feb 08(n=15-136)
% R
ate
"1
" o
r "2
"
Transportation to medical care Support for visiting family & friends
Pay issues Medical claims
Personnel orders Patient and family's needs
Getting urgent care as soon as needed Getting an appointment as soon as needed
All health care Personal doctor
Specialists Getting treatment or counseling
Outpatient Health Care-Ratings over Time (Points on Graph Reflect the Percentage of Participants in the Month Shown
Who Responded with a Rating of “1” or “2” on the 5-point scale)
PreferredDirection
Noteworthy:Very few problems with doctors, or health care relative to concerns with access
23
Self-Reported Health Status Ratings over Time(Percentage of survey participants rating their Overall Health or Mental Health as “1” or “2” on 5-point scale; % indicating health is worse than before deployment)
PreferredDirection
Overall health
Health compared to before
Mental health
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
May 07(n=415-
416)
Jun 07(n=439-
443)
Jul 07(n=215-
216)
Aug 07(n=204-
205)
Sep 07(n=234-
234)
Oct 07(n=217-
218)
Nov 07(n=331-
337)
Dec 07(n=242-
242)
Jan 08(n=186-
187)
Feb 08(n=194-
194)
% R
atin
gs
1 o
r 2
or
Mu
ch w
ors
e/w
ors
e
Overall health Health compared to before Mental health
24
Backup Slides
25
26
Post-deployment Health Assessment Key Results - Cumulative1 January 2003 – 17 April 2008
Medical/ Dental
Problems
Health
(Excellent, Very Good,
Good)
Currently on Profile
Mental Health
Concerns*
Referral Indicated for any reason
93% 23% 7% 31% 20%
90% 42% 12% 29% 25%
Summary of responses for all Service members
with a DD Form 2796 submitted since 01 Jan 03,
all operations/deployments
Data Source: Defense Medical Surveillance System,
As of 17 April 2008
Active Duty
(N = 830,207)
Reserve Components(N = 440,832)
* Service member reported mental health concerns: any positive response to Questions 11-13
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