INJURY PREVENTION REPORT NO. 12-HF-04MT-08, DEC 08

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A SYSTEMATIC EVIDENCE-BASED PROCESS FOR SETTING PRIORITIES AND
PREVENTING INJURIES: RECOMMENDATIONS FOR THE MILITARY.
A. INTRODUCTION. Injuries are the biggest health problem confronting U.S. military forces in peacetime and combat operations, resulting in over 1.8 million medical encounters annually across the Services and affecting more than 800,000 individual Service members. Not only are injuries the biggest health problem of the Services, but they are also a complex problem. The leading causes of deaths are different from those that result in hospitalization, which are different from those that result in outpatient care. As a consequence, it is not possible to focus on just one level of injury severity if the impact of injuries on military personnel is to be reduced. To effectively reduce the impact of a problem as big and complex as injuries requires a systematic approach. The purpose of this summary is to introduce the concepts behind a systematic approach to injury prevention.

USAF Flight Surgeon Survey: Aircrew Mental Health Referrals and Satisfaction with Local Mental Health Providers Response

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This study surveyed USAF flight surgeons world-wide regarding their experiences with aircrew needing mental health services. Participants were asked to review their caseload of active duty aircrew members over the past 12 months to answer survey items assessing: a. common psychological problems among aircrew leading to mental health referrals, b. referral rates and frequency of mental health referrals, c. modality of referrals, d. satisfaction with availability, timeliness and quality of mental health care provided to aircrew, as well as e. perceived difficulties with mental health provider response to referrals for aircrew mental health care. Out of 1504 aircrew members identified as needing mental health care, only 879 (58%) were referred to their local clinics, and reasons for lower referral rates were addressed. Common psychological problems leading to aircrew referrals included: marital difficulties, anxiety/depression related symptoms, alcoh! ol related incidences, adjustment disorders, and operational stress. Difficulties with mental health provider responses included: lack of understanding of aeromedical policy, failure to coordinate with flight surgeons when placing an aviator on a psychiatric profile, and a general lack of understanding of the aircrew community and culture. Implications and recommendations are discussed to overcome identified obstacles and improve the partnership between flight surgeons and mental health providers at USAF installations.

How Should Air Force Expeditionary Medical Capabilities Be Expressed

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Snyder, Don, Chan, Edward W., Burks, James J., Amouzegar, Mahyar A., Resnick, Adam C.


The Air Force Medical Service (AFMS) provides care both at home stations and in deployment missions. Two platforms provide its deployment component: Expeditionary Medical Support (EMEDS) and the aeromedical evacuation system. These have evolved over the years to provide increasingly better care to service members during deployments. Much of this success can be credited to the concept of operations (CONOPS) of these systems and the tailoring of manpower and equipment to that concept. The operational emphasis of expeditionary medicine is on patient flow. An injured patient receives limited treatment locally and is then moved from the point of injury to an EMEDS facility as quickly as possible. There, the patient is further evaluated, stabilized, triaged, treated, and evacuated to a higher level of care. Each level of care is designed to be sufficient for immediate needs, not to provide definitive care. This emphasis on flow streamlines capabilities ! that need to be deployed and places the definitive care in the most capable facilities. Although this framework has functioned well for the mission of supporting the warfighter, two areas need improvement. First, the most common current measure of capability, both within but especially outside the Air Force, is the number of available "beds." Yet, other than the final inpatient facilities that provide definitive care, the components of the expeditionary en route medical system are not intended to hold patients per se. Rather, patients are processed as quickly as is prudent and handed off to the next level to receive further care. The measure of beds does not adequately reflect this concept of operations, and requests that are stated in terms of beds are not likely to deliver the proper set of resources to meet the real requirements.

Accelerated Decompression from Saturation at 132 Feet of Sea Water With Isobaric oxygenation at 60 Feet of Sea Water

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Survivors of a disabled submarine (DISSUB) would experience a rise in internal pressure, and, if awaiting rescue long enough, become saturated increasing their risk of decompression sickness (DCS) to nearly 80% Previous work has demonstrated that breathing hyperbaric oxygen before decompression reduces the risk of DCS. A combination of oxygen pre-breathe, coupled with a shorter decompression schedule would enable the safe extraction of survivors from a DISSUB for subsequent re-pressurization in a chamber for a controlled decompression on the surface. Yorkshire swine (70 kg) were catheterized with an external jugular catheter via the Seldinger technique and allowed to recover. Subjects were exposed to 132 feet of seawater (fsw) in a hyperbaric chamber for 22 hr, then decompressed on one of 3 possible profiles (staged, rapid, mixed gas). The accelerated decompression examined here supports its consideration in emergency situations such as DISSUB. Fu! rther decompression schedules with oxygen pre-breathing merit additional study.

Medical Surveillance Monthly Report (MSMR). Volume 16, Number 01, January 2009

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According to the 2005 DoD Survey of Health Related Behaviors, 61% of men and 39% of women serving in the active component of the U.S. military had a body mass index above 25 kg/m2 and thus were nominally ?overweight?. Twelve percent of active service members were nominally obese (BMI>30 kg/m2), up from less than 5% in 1995. Stress and return from deployment were the most frequently cited reasons for recent weight gain. To ensure a mission-ready force with a "military appearance," the Department of Defense mandates that each military Service implement "body composition programs," including enforcement of weight-for-height standards required for accession and advancement. An increasing number of young adults in the general population do not meet the current weight-for-height standards. Among 18-year olds who applied for military service in 2006, 35% of males and 28% of females had a BMI above 25 kg/m.4 Eighteen-year old military applicants may have ! a higher prevalence of overweight than eighteen-year olds in the general population. Despite physical fitness and body fat standards, many active service members receive clinical diagnoses of overweight during routine medical examinations and other outpatient encounters. This report documents prevalences and trends of outpatient medical encounters for overweight/obesity among active component members of the U.S. Armed Forces during the past 11 years. Th e surveillance period was January 1998-December 2008. Th e surveillance population included all individuals who served in the active component of the U.S. military any time during the surveillance period. Outpatient records routinely maintained in the Defense Medical Surveillance System were searched to identify U.S. military members with diagnoses of ?overweight/obesity.? For this report, the endpoint of data summaries and analyses were outpatient medical encounters with diagnoses specifi c for/suggestive of overweight/obes! ity (?clinical overweight?).