IOM report offers guidelines to protect health of deployed U.S. forces

WASHINGTON, February 6, 2001 (GulfLINK) - The National Academy of Science's Institute of Medicine released in October 2000 a comprehensive report outlining future strategies for protecting the health of American deployed troops. The report says the Department of Defense should move more quickly as it implements changes recommended by the IOM.

One major reason for the lack of progress, cites the IOM, is that no single authority exists within DoD with the responsibility for implementing new initiatives that will better protect the health of deployed forces in the future.

"I agree with the IOM that DoD must act to protect those involved in future deployments," said Dale Vesser, acting special assistant for Gulf War illnesses, medical readiness and military deployments. "This is why in recent years we have stressed the importance of a follow-on organization to expand on what we have been doing for the past four years and to address health-related matters not only for past deployments, but for the future as well."

In August 2000, the office was tasked to advise the secretary of defense on the force health protection aspects of all military deployments. The work previously focused on Gulf War-related issues now also includes past and current deployment-related concerns. He says this effort is important because the Defense Department isn't well structured to deal with non-traditional issues.

"We need to remain vigilant, to make sure the mistakes DoD made in the Gulf War aren't repeated," said Vesser. "The findings of the IOM will become a very useful tool as DoD considers improvements."

The IOM report, "Protecting Those Who Serve: Strategies to Protect the Health of Deployed U.S. Forces," describes in depth six major strategies and recommendations that are needed to protect the health of deployed U.S. forces. It mentions the critical importance of integrated health risk assessment, improved medical surveillance, accurate troop location information and better exposure monitoring to force health protection.

The report was written in response to a need cited by then-Deputy Secretary of Defense John White in the summer of 1996. White asked the National Research Council and the IOM to explore the idea of a proactive approach of learning from the lessons of the Gulf War and other recent deployments - Somalia, Haiti and Bosnia - and to develop a strategy to better protect the health of U.S. troops in future deployments.

In recent years, U.S. troops have frequently deployed to various smaller contingency operations that can involve anything from peacekeeping missions to disaster relief with the risk ranging from low to high. As of February 2000, more than 40,000 U.S. personnel were deployed to 15 operations, with the largest number of personnel - 16,000 participants - engaged in Operation Southern Watch.

The proposed approach is based on four reports completed from the first two years of study. From these reports - along with briefings by the principal investigators and input from veterans and other subject-matter experts - the committee selected six strategies where actions are needed to protect the health of the deployed forces.

The first strategy proposed by the IOM is a systematic process to prospectively evaluate non-battle-related risks associated with the activities and settings of deployments. The report says DoD and the military services have made progress in their programs and processes, but cites the need for improved integration of the gathered information and methods of conveying the information to decision-makers.

The second strategy proposes a number of DoD activities - the who, what, when and where of a deployment. This includes collecting and reporting environmental data in concert with personnel locations; collecting individual biological samples; recording activity data to facilitate analysis of deployment exposures; and supporting clinical care and public health activities.

The third strategy emphasizes developing risk assessments, risk management and risk communication skills. That is, leaders at all levels must be able to evaluate potential hazards and, based on that information, develop protective measures. Most importantly, they then provide the troops with this information

"The acknowledgement of uncertainty does not erode trust and confidence in leaders, rather, it fosters confidence in the reliability of information deemed to be more certain and valid," the report says.

Building on an earlier report, the fourth strategy recommends accelerating implementation of DoD's ongoing health surveillance system. This relatively new concept spans the life cycle of the servicemember from the time he or she enters the military and continues after separation from service. Information requirements cited include health history, health status information on recruits, periodic updates of health status information that continue after deployment, improved laboratory-based surveillance, and preventive medicine and health surveillance.

The IOM also recommends that DoD implement strategies to address medically unexplained symptoms in deployed servicemembers. This serves as another means to address an issue of importance to servicemembers and their families, the report says.

"The DoD has an important opportunity to build upon this information base with additional research. Not only can the military health system explore the effectiveness of management and treatment options by evaluating health outcomes, it can also expand understanding of some of the predisposing, precipitating and perpetuating factors for medically unexplained symptoms."

Finally, the IOM recommends that DoD use technology to improve medical recordkeeping. In the nine years following the Gulf War, improvements have been slow, the report says. The IOM notes an important need to implement a joint computerized patient record and other automated record-keeping that meets the information needs of those involved with individual care and military health. The committee sees this as one of the most important challenges to protecting the health of deployed forces today.

The report urges DoD to pursue change quickly. Noting that a number of the recommendations outlined in the report are restatements of recommendations made before, the report says failure to move briskly on these fronts will further erode the traditional trust between the servicemember and the leadership.

"We agree," says Vesser. "We will consider the strategies formulated by the IOM as a guide for further work. We now know of many potential environmental and battlefield exposure risks of which our grandfathers and fathers were unaware. We owe it to our troops to be better prepared for anything that may affect their health and well-being."