1. DoD Health from the Battlefield Michael E. Kilpatrick, M.D. Deputy Director, Deployment Health Support Directorate 26 August 2006

2. 2 DoD Force Health Protection Providing a Full Continuum of Care

3. 3 DoD Health Surveillance Continuum Service Member Health Assessments Retirement/ Separation & Beyond Post- Deployment Reassessment Transit Force Health Protection Annual Preventive Health Assessment or Sep/Retirement Re-Deployment Operation Pre-Deployment Deployed In Garrison Accession Population Health

4. 4 4 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

5. 5 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

6. 6 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

7. 7 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

8. 8 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

9. 9 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 MechanismTBI Severity of Injury 11%

10. 10 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 Forces Minimal 15298 Water 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 known Moderate Air Moderate health risk, but in most cases would require consumption of a water source for prolonged periods of time Moderate Water Treated Media Contaminants are unlikely to result in high enough exposures to cause adverse health effects Minimal Soil Status of OEF/OIF Deployment Occupational & Environmental Health Monitoring > 14,000 samples analyzed in theater

11. 11 Distribution of Self-reported General Health Status: Pre-Deployment/Post-Deployment/Post- Deployment Re-assessment DMSS Data July 2006

12. 12 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

13. 13 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

14. 14 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.

15. 15 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

16. 16 555,478OIF 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 Utilization 2002 - 2QTR 2006

17. 17 Annual Health Assessments Periodic/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)

18. 18 Resources Military One Source (800) 342-9647 www.militaryonesource.com Military Severely Injured Center (800) 774-1361 severelyinjured@militaryonesource.com Army Wounded Warrior Program (800) 833-6622 www.armyds3.org Marine for Life (866) 645-8762 injuredsupport@M4L.usmc.mil Air Force Palace HART (888) 774-1361 severelyinjured@militaryonesource.com Navy Safe Harbor (888) 774-1361severelyinjured@militaryonesource.com 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

19. 19 Contact Information DHSD Veterans’ Helpline - (800) 497-6261 E-mail - special.assistant@deploymenthealth.osd.mil GulfLINK - http://www.gulflink.osd.mil DeploymentLINK - http://deploymentlink.osd.mil Michael.Kilpatrick@deploymenthealth.osd.mil