Medical Fitness for the 21 st Century Warfighter: An Introduction

1. Medical Fitness for the 21st Century Warfighter: An Introduction Francis G. O’Connor, MD, MPH Consortium for Health and Military Performance (CHAMP) Uniformed Services University of the Health Sciences

2. Objectives Describe: What is Medical Fitness Introduce: Current DoD Examples of Medical Fitness

3. What is Medical Fitness? • Fitness: • The state or condition of being physically sound and healthy, especially as the result of exercise and proper nutrition. • A state of general mental and physical well-being. • The state of being suitably adapted to an environment. • Medical: • relating to the study or practice of medicine. • Medical Fitness • Accordingly Medical Fitness would be best described as a state of general mental and physical well-being, as determined by medical metrics.

4. Does Medical Fitness equal Medical Readiness?

5. AR 4-501: Standards of Medical Fitness • Medical Fitness • Free of contagious diseases that would likely endanger the health of other personnel; • Free of medical conditions or physical defects that would require excessive time lost from duty for necessary treatment or hospitalization or would likely result in separation from the Army for medical unfitness; • Medically capable of satisfactorily completing required training; • Medically adaptable to the military environment without the necessity of geographical area limitations; • Medically capable of performing duties without aggravation of existing physical defects or medical conditions. Health as Applied to Function in Military Service!

6. Modification 9 to USCENTCOM Individual Protection and Individual/Unit Deployment Policy • “ALL PERSONNEL DEPLOYING TO THEATER MUST BE MEDICALLY (TO INCLUDE DENTAL) AND PSYCHOLOGICALLY FIT FOR DEPLOYMENT. • FITNESS INCLUDES, BUT IS NOT LIMITED TO, THE ABILITY TO ACCOMPLISH THE TASKS AND DUTIES UNIQUE TO A PARTICULAR OPERATION, AND ABILITY TO TOLERATE THE ENVIRONMENTAL AND OPERATIONAL CONDITIONS OF THE DEPLOYED LOCATION, INCLUDING WEAR OF PROTECTIVE EQUIPMENT AND USE OF REQUIRED PROPHYLACTIC MEDICATIONS.”

7. Modification 9 to USCENTCOM Individual Protection and Individual/Unit Deployment Policy • Medical Fitness for Deployability: • The condition(s) is/are not of such a nature that an unexpected worsening or physical trauma is likely to have a medically grave outcome; • The condition(s) is/are stable; that is, currently under medical care, and reasonably anticipated by the pre-deployment medical evaluator not to worsen during the deployment under available care in theater, in light of physical, physiological, psychological and nutritional impacts and effects of the duties, location, and limited medical capabilities at the location. • Any required ongoing health care or medications must be available in theater within the military health system for DoD personnel or the contractor health care system for contingency contractor personnel, unless specifically authorized in the contracting officer's Letter of Authorization and the synchronized pre-deployment operational tracker database and have no special handling, storage, or other requirements (e.g., refrigeration/cold chain, electrical power, etc.). • No need or anticipation of duty limitations that preclude performance of duty or an accommodation imposed by the medical condition. • There is no need for routine evacuation out of theater for continuing diagnostics or other evaluations (all such evaluations must be accomplished prior to deployment).

8. Medical Metrics Green: Periodic Health AssessmentYour next Physical Exam is due by 1/14/2010. Your current PULHES code, which impacts your medical readiness, is: 111111.

9. Commander’s Checklist • Periodic Health Assessment to Include DNA • Disease Surveillance to include HIV/TB • Routine Immunizations • Chemoprophylaxis • Dental Readiness • Vision Readiness • Hearing Readiness • Baseline Neurocognitive Assessment • Risk Factor Assessment (Disease and Injury) • Family History • Nutrition • Behavioral • Targeted HPO Assessment • Supplements/Nutraceuticals • Drugs • Techniques • Machines

10. The Future • Functional Testing • Biomarkers • Genetics • Assessment and Exploitation of Potential Adversary

11. For further information please contact:champ@usuhs.mil Dr. Francis G. O'Connor, COL, MC, USAMedical Director, Uniformed Services University Consortium for Health and Military PerformanceAssociate Professor301 295-2270    foconnor@usuhs.mil Dr. Patricia Deuster, Ph.D., M.P.H.Scientific Director, Uniformed Services University Consortium for Health and Military PerformanceProfessor301 295-3020    pdeuster@usuhs.mil