Strategies to Protect the Health of Deployed U.S. Forces Medical Surveillance, Record Keeping, and Risk Reduction (1999) / Chapter Skim
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6 Prevention Measures for Deployed Forces
6 Prevention Measures for Deployed Forces
Pages 92-120
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From page 92... ...
After a general discussion of risk communication, this chapter considers preventive measures for different stages of the deployment cycle. RISK COMMUNICATION Risk communication is a critical process in public health and is a critical process in military health as well.
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From page 93... ...
Initially the term risk communication was commonly used to describe one-way messages from experts to nonexperts, but in the last decade there has been a shift of focus from merely the messages themselves to the entire process (National Research Council, 1989~. The National Research Council report, Improving Risk Communication, described risk communication "as an interactive process of exchange of information and opinion among individuals, groups, and institutions" (p.
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From page 94... ...
Because of the complexity of the topic and the possibility of wide variability among providers, specific guidelines are needed concerning what providers say to patients about medically unexplained symptoms, and training is needed to ensure that they follow these guidelines. In the years since the Gulf War, portions of both the U.S.
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From page 95... ...
The Clinical Working Group of the Persian Gulf Veterans Coordinating Board has also recently released a revised version of their risk communication plan. The Comprehensive Risk Communication Plan for Gulf War Veterans "is designed to improve federal efforts to provide a clear and accurate dialog on the health consequences of Gulf War service" (Persian Gulf Veterans Coordinating Board, 1999, p.
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From page 96... ...
Risk communication should include an introduction to medically unexplained symptoms. To better address the specific concerns of the
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From page 97... ...
The study team commissioned Jean Johnson, R.N., Ph.D, to write a paper that addresses the question, "What does the research on informational interventions to reduce the stress of medical procedures tell us about communicating to troops the risks of deployment? " Her review of the evidence suggested that the provision of sensory and procedural information to patients before medical ordeals is often benef~cial in reducing outcomes such as pain, emotional distress, poor psychological well-being, medical complications, and length of hospital stay (Johnson, 1998~.
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From page 98... ...
Findings and recommendations about risk communication are provided at the end of the chapter. PREVENTIVE MEASURES BEFORE DEPLOYMENT Preventive measures that take place before a deployment include those that occur upon entrance into the service, during training and routine garrison life, and immediately before a deployment.
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From page 99... ...
An important change in the system took place in 1998, when the Accession Medical Standards Directive was revised to use the 9th revision of the International Classification of Diseases to track disqualifying, waived, or medically discharged conditions. This system will provide a means of assessing the effectiveness of the standards and the medical experiences of people granted waivers for otherwise disqualifying medical conditions through research carried out by
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From page 100... ...
. Retention Standards Reports following the Gulf War suggested that some service members who were deployed to it were not medically fit to carry out their missions (Presidential Advisory Committee on Gulf War Veterans' Illnesses, 1996a)
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From page 101... ...
Retention standards are periodically reviewed by the services' medical specialty consultants for necessary updates. With limited information gathering on this topic, the study team did not note any problems with the retention standards themselves the challenge for the services is to implement them effectively.
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From page 102... ...
, it is important that service members learn about typical health risks during deployments and the appropriate countermeasures during their training. Early attention to such issues conveys the message that they are taken seriously by the services, and is likely to increase the level of adherence to further risk reduction instructions offered during deployments Medical training on treatment is introduced in basic courses when care providers enter the services, and additional training is provided over time.
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From page 103... ...
For immunizations unique to the military, the departments develop appropriate procedures in consultation with the Armed Forces Epidemiological Board, the Armed Forces Medical Intelligence Center, and the Armed Forces Pest Management Board, as needed (U.S. Department of Defense, 1986~.
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From page 104... ...
A special policy exists for immunizations against biological warfare threats and is detailed in DoD Directive 6205.3, Immunizations Program for Biological Warfare Defense ( |
From page 105... ...
Reliance on smaller companies with less manufacturing capability and expertise has resulted in an unreliable supply of vaccines. At present DoD has no manufacturer for the live oral adenovirus type 4 and type 7 vaccines, which are needed to prevent epidemics of acute febrile respiratory disease in recruit training camps (Gray et al., 1999~.
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From page 106... ...
The study team urges DoD to reconsider the concept of government production facilities for vaccines. Identification of Biological Warfare Threats Annually and as required, the Chairman of the Joint Chiefs of Staff in consultation with the Commanders of the Unified Commands, the Chiefs of the Military Services, and the Director of the Defense Intelligence Agency must validate and prioritize the biological warfare threats to DoD personnel.
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From page 107... ...
However, the Secretary of Defense announced plans in December 1997 to ultimately vaccinate all U.S. military personnel against anthrax, a biological warfare agent.
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From page 108... ...
The public relations challenge is also considerable. The anthrax vaccine is among the many agents to which service members in the Gulf War were exposed and that veterans have considered to be a possible contributor to or cause of illnesses among Gulf War veterans.
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From page 109... ...
Procedures are needed to ensure that concerns about emerging problems are shared across levels, facilitating their recognition and investigation and aiding in the development of well-considered communications. Combat Stress Reactions and Control As noted in Chapter 2, the importance of unit cohesion in affecting the rates of psychiatric breakdown in combat came to be recognized in World War II.
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From page 110... ...
Programs, requires that each of the services implements plans to "enhance readiness, contribute to combat effectiveness, enhance the physical and mental health of military personnel, and to prevent or minimize adverse effects of Combat Stress Reactions" (U.S. Department of Defense, 1999a, p.
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From page 111... ...
Use of Investigational New Drugs by the Armed Forces Among the several force protection issues highlighted by the experiences of the Gulf War have been the difficulties surrounding the use of drugs or biologics that have not been licensed by the FDA. FDA grants licensure to drugs or biologics that have been shown to be both safe and efficacious for the use in question.
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From page 112... ...
The Interim Rule had several requirements, including that the FDA decision must be based on a finding that obtaining informed consent is not feasible, that withholding treatment would be contrary to the best interests of military personnel, and that no satisfactory alternative product is available. The use of PB and BT in the Gulf War was characterized by poor record keeping, inadequate data collection, and other violations of the terms agreed to in the FDA waivers (Rettig, 1999~.
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From page 113... ...
Health concerns and health problems are almost certain given the experiences of previous major deployments, and deployed forces will need information to understand them. As discussed in the Comprehensive Risk Communication Plan for Gulf War Veterans (Persian Gulf Veterans Coordinating Board, 1999)
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From page 114... ...
, and this approach has proven to be effective in many cases. Because medically unexplained symptoms are a prevalent and persistent problem that is associated with high levels of subjective distress and functional impairment and with extensive use of medical care, the study team believes that it is important to institute an aggressive program of early diagnosis and symptomatic treatment.
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From page 115... ...
Primary care providers will require in-service training and workshops to become more knowledgeable about, comfortable with, and proficient in this clinical approach. The study team believes that a program of continuing education should be undertaken for all military primary care providers to improve their clinical ability to diagnose and treat medically unexplained symptoms.
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From page 116... ...
Current knowledge and understanding of medically unexplained symptoms are inadequate, particularly in light of their high prevalence and costs in personal distress and suffering, functional disability and impaired productivity, and ineffective and inefficient medical care. Prospective studies are necessary to assess the role of predisposing causes (such as a prior history of medically unexplained symptoms, psychiatric disorder, and trauma or abuse)
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From page 117... ...
should designate and provide resources to a group within DoD that is given primary responsibility for developing and implementing a plan to achieve the risk communication goal articulated in the National Science and Technology Council's Presidential Review Directive. Such a plan should · Involve service members, their families, and outside experts in developing an explicit set of risk communication topics and goals.
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From page 118... ...
Lack of effective preventive medicine training can compromise the health of deployed forces .
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From page 119... ...
Department of Defense develop an improved strategy for addressing medically unexplained symptoms involving education, detection, mitigation, evaluation, and research. · Undertake a program of continuing education for military primary care providers to improve their clinical ability to diagnose, treat, and communicate with patients with medically unexplained symptoms.
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From page 120... ...
· Treat medically unexplained symptoms in the primary care setting whenever possible, with referral to more intensive programs as necessary. · Carry out a research program with prospective studies to assess the role of predisposing, precipitating, and perpetuating factors for medically unexplained symptoms.
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