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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 [email protected]
Army Wounded Warrior Program (800) 833-6622 www.armyds3.org
Marine for Life (866) 645-8762 [email protected]
Air Force Palace HART (888) 774-1361 [email protected]
Navy Safe Harbor (888) 774-1361 [email protected]
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 - [email protected]
• GulfLINK - http://www.gulflink.osd.mil
• DeploymentLINK - http://deploymentlink.osd.mil
