Informing the Future Critical Issues in Health, Sixth Edition (2011) / Chapter Skim
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Military and Veterans: Protecting the Protectors
Military and Veterans: Protecting the Protectors
Pages 59-72
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From page 59... ...
Roughly 2.1 million men and women, including those drawn from military reserve units and the National Guard, have served in Iraq during Operation Iraqi Freedom and in Afghanistan during Operation Enduring Freedom, often experiencing multiple deployments.
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From page 60... ...
Numerous media reports For many service members, have suggested that for many service memthe challenge of readjustment bers, the challenge of readjustment is made is made worse by various worse by various health problems, includhealth problems, including ing post-traumatic stress disorder (PTSD) post-traumatic stress disorder and traumatic brain injury (TBI)
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From page 61... ...
Requests for disability care and com 100 pensation by veterans of previous wars did not peak until 30 years or more after their service ended, and this pattern may hold for Iraq and Afghanistan military personnel and their families as well. The VA currently lacks a 50 mandate and resources to make such long-range projections, limiting the 0 Active Air Force e Marine Corps Guard Air Force serve Air Force e Marine Corps Reserve Navy Active Navy Guard Army Active Army Reserve Army
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From page 62... ...
In recent studies of methods for treating TBI, there is evidence that nutritional interventions in the minutes or hours following injury may be effective in improving health outcomes and may even offer some degree of resilience to TBI. In light of such findings, the DoD asked the IOM to convene an expert committee to review the potential role of nutritional interventions.
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From page 63... ...
Early feeding is likely to limit the person's inflammatory response, which typically is at its peak during the first 2 weeks after an injury, and thereby improve the ultimate health outcome. The committee recommends that the DoD take the lead in developing feeding protocols that require standardized early nutrition delivery for patients with severe TBI, and that hospital intensive care units that treat military personnel should include these protocols in their critical care guidelines.
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From page 64... ...
At the request of Congress, the IOM has conducted a series of studies that have examined the scientific and medical evidence on the health effects of the various agents to which military personnel may have been exposed. Beginning in 2000, the IOM has reported on numerous health outcomes related to possible exposures in the Gulf; that work has resulted in the studies in the Gulf War and Health series, which currently includes eight volumes.
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From page 65... ...
These psychiatric disorders persist for at least 10 years after deployment. • Gastrointestinal symptoms consistent with functional gastro intestinal disorders such as irritable bowel syndrome and func tional dyspepsia.
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From page 66... ...
This effort should include assembling methodologically robust cohort groups and carefully tracking their development of a number of dis eases, including ALS, multiple sclerosis, brain cancer, and psychiatric con ditions, as well as health problems that occur at a later age, such as other cancers, cardiovascular disease, and neurodegenerative diseases. On another front, renewed effort is needed to better understand the multiRenewed effort is needed symptom illness that affects an estimated to better understand the 250,000 Gulf War veterans.
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From page 67... ...
Included will be a 5-year study to evaluate the impact of resistance exercise training in treating chronic musculoskeletal pain and related symptoms, a 4-year study using an animal model of multisymptom illness to assess therapies designed to enhance mood and memory, and a 2-year pilot study to compare the effectiveness of certain stress-reduction therapies with conventional care in treating Gulf War veterans. In addition to funding new research, the VA has asked the IOM to evaluate treatments being used to manage chronic multisymptom illness and to recommend those that seem to offer the most benefit and improved health outcomes in those veterans experiencing chronic symptoms.
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From page 68... ...
Work also needs to be undertaken promptly to resolve questions regarding several health outcomes, most urgently tonsil cancer, melanoma, and paternally transmitted transgenerational effects. As a result of the IOM report, Secretary of Veterans Affairs Eric Shinseki announced plans in October 2009 to add Parkinson's disease, ischemic heart disease, and hairy cell leukemia to the list of conditions presumed to be associated with exposure to Agent Orange.
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From page 69... ...
Thus, it is currently impossible to judge whether Blue Water Navy Vietnam veterans might be at higher, lower, or similar risk of long-term adverse health effects associated with Agent Orange exposure than shorebased veterans or Brown Water Navy veterans. Safeguarding mental health Combat troops in today's wars in Iraq and Afghanistan, as well as their counterparts Combat troops in today's in other wars, face exposure to a range of wars in Iraq and Afghanistan traumatic events that can cause immediate face exposure to a range of or delayed mental health conditions.
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From page 70... ...
The committee recommends that counselors who do not meet the proposed requirements still be allowed to practice within the system to maintain the continuity of care, and that TRICARE consider supervising them in a manner that provides for successively greater levels of independent practice as experience and demonstrated competence increase. The committee also recommends a more fundamental step, that TRICARE implement a comprehensive quality management system for all of its mental health professionals.
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From page 71... ...
71 Military and Veterans: Protecting the Protectors After the report's release, the IOM, at the request of the DoD, held a 3-day workshop in October 2010 to explore the possible structure and implementation of the recommended quality management system. The workshop brought together participants from a variety of groups and with a range of interests, and the discussions are expected to inform efforts to improve the way that TRICARE serves the mental health needs of its beneficiaries.
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