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

2 DoD Force Health Protection Providing a Full Continuum of Care

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 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, days 7,450<14 days Unique Service MembersLength of Deployment

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 59% 22%19% 0% 10% 20% 30% 40% 50% 60% 70% Disease Non-Battle Injury Battle Injury From , the total MATs of individual servicemembers = 34,395 Data Source: USTRANSCOM TRAC2ES As of 24 July 2006 Medical Air Transports of Individual Servicemembers

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 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 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 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 Water Untreated # of Samples Comments # 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 Distribution of Self-reported General Health Status: Pre-Deployment/Post-Deployment/Post- Deployment Re-assessment DMSS Data July 2006

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 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 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 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

16 555,478OIF 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 QTR 2006

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 Resources Military One Source (800) Military Severely Injured Center (800) Army Wounded Warrior Program (800) Marine for Life (866) Air Force Palace HART (888) Navy Safe Harbor (888) DHSD Deployment Helpline (800) Deployment Health Clinical Center DeploymentLINK Deployment Health and Family Readiness Library

19 Contact Information DHSD Veterans’ Helpline - (800) GulfLINK - DeploymentLINK -