Strategies to Protect the Health of Deployed U.S. Forces Medical Surveillance, Record Keeping, and Risk Reduction (1999) / Chapter Skim
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4 Medical Surveilance
4 Medical Surveilance
Pages 41-71
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From page 41... ...
defines epidemiologic surveillance as: the ongoing and systematic collection, analysis, and interpretation of health data in the process of describing and monitoring a health event. This information is used for planning, implementing, and evaluating public health interventions and programs.
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From page 42... ...
During its investigation, the study team has learned of a variety of different health surveillance initiatives and efforts that are planned or under way. Although each has its own justifiable goals, the disjointedness of the efforts makes it less likely that the goal of keeping the force healthy during a deployment will be reached efficiently.
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From page 43... ...
The four critical elements of the Force Health Protection Strategy are threat analysis, countermeasures, medical surveillance in the area of operations, and analysis (National Science and Technology Council, 1998~. DoD Joint Directive In August 1997, DoD released the directive Joint Medical Surveillance (U.S.
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From page 44... ...
It anticipates that new systems will be developed to facilitate medical surveillance, such as automated medical record devices, and that a geographical information system will be used to conduct spatial analyses of the environmental and disease exposures of company-sized and larger units. The environmental exposure data will be capable of being linked to service members' individual medical records.
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From page 45... ...
National Science and Technology Council, Presidential Review Directive 5 In response to a recommendation from the Presidential Advisory Committee on Gulf War Veterans' Illnesses, a National Science and Technology Council Interagency Working Group developed an interagency plan to address health preparedness for and readjustment of veterans and families after future conflicts and peacekeeping missions. The resulting plan, released in November 1998, is called, A National Obligation: Planning for Health Preparedness for and Readjustment of the Military, Veterans, and Their Families after Future Deployments (National Science and Technology Council, 1998~.
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From page 46... ...
Recruit Assessment Program The military is developing a survey instrument proposed to be given to new military recruits immediately upon reporting for basic training. Although baseline health information is already obtained from recruits during Military Entrance Processing, it is limited in scope, is not computerized, and often is not
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From page 47... ...
The Institute of Medicine (IOM) study team views the collection of uniform survey data from recruits upon accession into the military as an important contribution both to the individual medical record and to a population database for better understanding the development of disease in military populations generally.
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From page 48... ...
The study team believes that it can serve a valuable function on both fronts with careful review, ref~nement, and incorporation of questions designed to note potential warning signs for the manifestations of medically unexplained symptoms, as discussed elsewhere in this report. It can also collect better information about reproductive health to facilitate surveillance for adverse reproductive outcomes addressed later in this chapter.
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From page 49... ...
The study team finds the serum bank to be a valuable component of the health surveillance system, with uses beyond assessment of the hazards of spe
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From page 50... ...
. Surveillance for Drug- and Vaccine-Associated Adverse Events Prevention of infectious diseases and protection of deployed forces from chemical and biological threats often require the use of vaccines, antiparasitic drugs, antibiotics, compounds that ameliorate the effects of nerve gas, and insect repellents.
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From page 51... ...
are important reasons for the emphasis on laboratory-based surveillance (Harrison and Pinner, 1998~. At the same time, the managed health care system has taken a toll on the laboratory capability for public health surveillance.
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From page 52... ...
The program has provided number of cases, case rates, and demographic data for several diseases of particular surveillance interest and might be considered a model of interest to the military. The study team finds that measures are needed to reinforce the laboratory capability for public health surveillance within the military.
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From page 53... ...
Department of Defense Serum Repository; DIOR = Directorate for Information, Operations and Reports; HRA = Health Risk Appraisals; CHPPM = U.S. Army Center for Health Promotion and Preventive Medicine; MTF = Military Treatment Facility; K = thousand; and M = million.
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From page 54... ...
They have proved to be a uniquely capable test bed for treatment and preventive medicine measures against a host of militarily important diseases such as malaria, leishmaniasis, hepatitis, bacterial diarrheas, Japanese encephalitis, scrub typhus, leptospirosis, and dengue (Gambel and Hibbs, 1996~. In addition to carrying out testing of diagnostic tests, vaccines, chemoprophylactic agents, and insect repellents to benefit both military and civilian populations, the overseas laboratories have provided sophisticated laboratory support during military deployments such as Operations Desert Shield and Desert Storm (the Gulf War)
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From page 55... ...
As infectious disease threats continue to change and emerge worldwide, the value of these laboratories to military preventive medicine increases. However, funds and personnel resources for these laboratories have been substantially reduced over the past several years, diminishing the ability of these units to carry out their missions (Institute of Medicine, 1999a)
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From page 56... ...
The information management community is responsible for the development of automated medical surveillance systems, and the preventive medicine community is only peripherally involved (Institute of Medicine, 1998~. Systems already in use by some services would not be readily applicable across the services because most Army battalion aid stations still do not have computers and are using "stubby pencil"technology(InstituteofMedicine, 1998, l999b)
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From page 57... ...
in future deployments is very likely to decrease, the problem of capturing data from care provided by host nations will continue or grow. Theater Medical Information Program TMIP is being planned as a system integration program that will coordinate functioning health information systems.
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From page 58... ...
Documentation of environmental exposures in individual medical records is a tremendously challenging task, but one that will be necessary to better address questions of long-term health risks from deployment exposures. Postdeployment Medical Surveillance Immediate Postdeployment Surveillance The new surveillance policies described earlier have brought changes in procedures for medical surveillance immediately after a deployment.
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From page 59... ...
The sample is intended to be collected while service members are still in the theater of operation, but failing that, it is to be collected within 30 days of the return home. As noted earlier, the study team believes that a regularly administered survey, such as an improved version of the HEAR, should obviate any benefit from pre- and postdeployment surveillance questionnaires.
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From page 60... ...
A survey instrument such as the HEAR must be used with consideration and acknowledgment of the characteristics of self-reported data. Several studies have indicated that health information provided through self-reporting is not necessarily concordant with data from more objective sources such as medical records (Gordon et al., 1993; Kriegsman et al., 1996; Fowles et al., 1997; Bergmann et al., 1998~.
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From page 61... ...
Together, these two programs have provided health evaluations to more than 100,000 veterans with health concerns related to their Gulf War service. Such registries were developed to meet a clear need in the veteran community for health care and for information about the deployment and the illnesses reported by Gulf War veterans.
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From page 62... ...
Surprisingly, much of the attention given to so-called adverse reproductive effects focuses on perinatal outcomes such as birth defects; less attention is given to the spectrum of potential reproductive and developmental outcomes. Surveillance for birth defects alone will not provide the military with a complete picture of reproductive health in deployed forces.
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From page 63... ...
Surveillance for birth defects may be of particular concern for ensuring the reproductive health of deployed forces given growing evidence about the developmental toxicities of many chemicals and related environmental exposures, reported clustering of defects in select subpopulations, and the emphasis on birth defects in the media. Ascertainment of birth defects is not a straightforward process and is often hindered by a lack of available data or mechanisms for identi
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From page 64... ...
Recently, upon completion of a feasibility study, the Emerging Illness Division of the Naval Health Research Center concluded that the construction of a DoD-wide birth defects registry is feasible using a hybrid of active and passive surveillance mechanisms (Bush et al., 1999~. Although such a registry might prove to be helpful in addressing concerns about birth defects following future deployments, a more sensitive indicator of reproductive health effects might be gathered through the collection and monitoring of reproductive health histories.
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From page 65... ...
Confidentiality of Health Information Several of the military's current and proposed instruments (both proposed by the military and recommended by this report) collect sensitive health-related data (e.g., mental health status, reproductive health issues, HIV infection status, childhood sexual abuse, and alcohol abuse)
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From page 66... ...
Finding 4-2: Annual collection of health risk information through a survey should facilitate the implementation of preventive measures within the entire military population and provide valuable baseline health information. The instrument should be carefully designed for maximum benefit of health assessments and preventive medicine efforts, including those for medically unexplained physical symptoms and reproductive health.
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From page 67... ...
Recommendation 4-2b: Refine the Health Evaluation and Assessment Review by drawing on additional survey instrument and subject matter experts. Make the categories more clinically relevant, and modify or add questions relevant to signs of medically unexplained physical symptoms (sleep disturbances or general symptoms without apparent medical explanation)
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From page 68... ...
Code diagnoses with levels of specificity comparable to those used for civilian health surveillance practices. Continue to provide increased resources to overseas laboratories for surveillance in regions of military interest.
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From page 69... ...
. Recommendation 4-9: Integrate the efforts of environmental surveillance, preventive medicine, clinical, and information technology personnel to ensure the inclusion of medically relevant environmental and other exposures in the individual medical record.
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From page 70... ...
Finding 4-12: Deployment-specif~c registries such as those established for Gulf War veterans do not fill the role of providing medical surveillance in a way that would be desirable after future deployments. Although they do capture health information from veterans who are concerned about their health, they are not based on a case definition of an illness.
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From page 71... ...
that play or that could play a role in providing health surveillance information for military populations. These tools have not been planned to be part of a coordinated system of health surveillance and preventive medicine, and thus are not maximally efficient.
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