Strategies to Protect the Health of Deployed U.S. Forces Medical Surveillance, Record Keeping, and Risk Reduction (1999) / Chapter Skim
Currently Skimming:
Executive Summary
Executive Summary
Pages 1-14
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 1... ...
physical protection and decontamination, and (4) medical protection, health consequences and treatment, and medical record keeping.
|
From page 2... ...
The study team was charged with addressing the following: · Prevention of adverse health outcomes that could result from exposures to threats and risks including chemical warfare and biological warfare, infectious disease, psychological stress, heat and cold injuries, unintentional injuries; · Requirements for compliance with active duty retention standards; · Predeployment screening, physical evaluation, risk education for troops and medical personnel; · Vaccines and other prophylactic agents; · Improvements in risk communication with military personnel in order to minimize stress casualties among exposed, or potentially exposed personnel; · Improvements in the reintegration of all troops to the home environment; · Treatment of the health consequences of prevention failures, including battle injuries, disease and non-battle injury (DNBI) , acute management, and long-term follow-up; · Surveillance for short- and long-term outcomes, to include adverse reproductive outcomes; and · Improvement in keeping medical records, perhaps using entirely new technology, in documenting exposures, treatment, tracking of individuals through the medical evacuation system, and health/administrative outcomes.
|
From page 3... ...
Effective application of an improved health surveillance system and an integrated computerbased patient record will require concerted leadership and coordination to prevent the inexorable tendency toward "stovepiping" that is, the development or continuation of an array of independent task- or service-specific systems that cannot meet the current needs for information exchange and follow-up. High-level leadership and coordination are also needed to effect changes in the way in which medically unexplained symptoms are addressed in military populations.
|
From page 4... ...
Taking those efforts into account, with this report the study team proposes additional and complementary strategies to more effectively address medically unexplained symptoms, medical surveillance, and medical record keeping for future deployments, as well as other aspects of prevention such as risk communication and reintegration. The report emphasizes the need to extend medical surveillance and record keeping and other protections to the reserve components.
|
From page 5... ...
Recommendations The study team recommends that the U.S. Department of Defense develop an improved strategy to address medically unexplained symptoms, involving education, detection, evaluation, mitigation, and research.
|
From page 6... ...
Part of the work of such a body would be to coordinate and potentially consolidate the surveillance tools referred to above, such as the Recruit Assessment Program to gather baseline data from incoming recruits, the Health Evaluation and Assessment Review (HEAR) and other sources of pre- and postdeployment self-reported health status data, surveillance systems for use during deployments, exposure assessment and environmental surveillance measures, and laboratory-based surveillance.
|
From page 7... ...
. Given the experiences after the Vietnam and Gulf wars, the postdeployment period is crucial for carrying out medical surveillance and providing appropriate care for returning service members.
|
From page 8... ...
· Annually administer Health Evaluation and Assessment Review (HEAR) to a representative sample of service members who have been separated from the service for 2 to 5 years after a major deployment to track health status and identify health concerns including medically unexplained symptoms.
|
From page 9... ...
(See full Recommendation 7-3.) MEDICAL RECORD KEEPING 9 Previous studies have cited deficiencies in medical record keeping as a major impediment to understanding and treating the health effects associated with deployment to the Gulf War (Institute of Medicine, 1996a; Presidential Advisory Committee on Gulf War Veterans' Illnesses, 1996b)
|
From page 10... ...
forces deployed abroad, however, a unified CPR system is essential. The study team recommends that a comprehensive review of the military health information systems strategy be undertaken to enumerate the information needs; define an expedient process for development of an enterprisewide technical architecture, common data model, and data standards; identify critical dependencies; establish realistic time lines; assess the adequacy of resources; and perform a realistic risk assessment with contingency plans.
|
From page 11... ...
With so much at stake, the study team recommends that an external advisory board participate in the effort by providing ongoing review and advice regarding the military health information systems strategy. Composed of members of academia and industry, this group would provide synergy and potential leverage between the military and civilian sectors in information systems.
|
From page 12... ...
Such a discussion can lead to goals for reducing those problems and means of evaluation and improvement. The risk communication efforts associated with the vaccination against anthrax, the risk communication goal articulated in Presidential Review Directive 5, the guide developed in response to recommendations from earlier independent advisory bodies, and the Comprehensive Risk Communication Plan for Gulf War Veterans (Persian Gulf Veterans Coordinating Board, 1999)
|
From page 13... ...
With medical record keeping, outside expert review is needed to provide ongoing input into the challenging effort of implementing a successful CPR for the military. The medically unexplained symptoms reported by veterans after the Gulf War have motivated many of DoD's constructive changes in medical surveillance and medical record keeping, but these initiatives cannot be anticipated to
|
From page 14... ...
Indeed, it is not yet known how medically unexplained symptoms can be prevented. Better medical surveillance and record keeping can lay the foundation so that similar questions can be more readily answered in the future, however, and permit better insights into questions of etiology.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.