Deployment Health Surveillance

1. Deployment Health Surveillance Lt Col Dennis Fay Operational Prevention Division AFMOA/SGZP

2. Life-Cycle Approach to Force Health Protection • Assess health annually, beginning at accession, and ensure ongoing individual medical readiness • Conduct pre-deployment threat assessments and medical screening; target preventive measures • During deployment, assess for environmental hazards and employ active health surveillance • Provide state-of-art expeditionary casualty care • Integrate deployment-related health records and any needs into life-long care

3. Regulatory Requirements • Public Law: S 1074 E/F “SecDEF shall establish system to assess medical condition of members of Armed Forces deployed overseas” • Pre/Post deployment medical exams • Record health status and care (mental health), serum samples, immunizations, etc) • Quality Assurance is required

4. Pre-Deployment • Continuously maintain Fit and Healthy Force; individual medical readiness (PIMR) • Pre-Deployment Health Risk Assessment • Develop site specific preventive medicine recommendations consulting with PCM teams and other medical professionals • Ensure deployees receive appropriate interventions before deployment

5. AFMS SG PIMR Metric

6. Base-level “Drill Down”

7. AF Commanders Own Force Health Protection—Online Toolkit Periodic Health Assessment and Individual Medical Readiness

8. Threat Assessments

9. Target Preventive Measures

10. Pre-Deployment Screening

11. During Deployment • Conduct in-theater environmental surveillance • Conduct on-going assessments and mitigation of potential environmental and occupational health hazards • Conduct food and water vulnerability assessments • Record medical encounters, environmental and occupational health exposures, known or potential exposure to NBC agents

12. Environmental Surveillance—Hazard Assessment Environmental • Environmental Sampling • Risk Assessment • Hazardous Material Management Public Health • Vector Surveillance • Food and Water Occupational Health & Safety • Industrial Hygiene • Environmental Health • Injury and illness • Risk Assessment

13. Environmental Surveillance—BW Detection • B/W Detection devices • Hand-held assays--individual agents • Ruggedized Advanced Pathogen Identification Device (RAPID)–able to reliably identify multiple BW agents

14. Disease & Injury Surveillance • Disease surveillance • Global Epidemiological Medical Support (GEMS)—integrates patient evaluation, Environmental Health Data, epidemiologic analysis, Command & Control • Patient Encounter Module (PEM)--paperless data link for front line medic to record and track individual patients • Theater Epidemiological Module (TEM)—far forward use, reports system with Command and Control surveillance

15. Personal Computers PSAB Central Server In Theater GEMS Real Time Analysis Collection Encryption Langley AFB, VA

16. Early Warning Possible Now -Real Time Analysis -BW Symptoms -C2 Response -Mitigation -Counter Measures Patient Record -Vitals -Exposure -Immunizations -Previous Encounters -Medications Population Medicine -Retrospective Analysis -Endemic Disease Rates -Baseline Disease Prevalence GEMS Advances Ability To Meet Requirements Of Force Health Protection Detailed Data For Enhanced DNBI Surveillance

17. Online Reporting

18. Post-Deployment • Post Deployment Health Questionnaire, DD Form 2796 (completed via face-face encounter with a provider) collected, completed and forwarded to AMSA • Collect post deployment serum sample w/in 30 days of return (JCS defined deployment)

19. Post-Deployment Screening

20. Expert Clinical Care

21. Quality Assurance What are we measuring? MAJCOM reports will provide information to generate the following AF metrics: - % returning personnel who completed post deployment health assessment (if required) - % returning personnel who have had serum sample collected (if required) - % returning personnel who require clinical referral and % of them who completed initial referral visit - % returning personnel who completed all required post-deployment checklist items

22. Quality Assurance Program • How are we doing? • Our data shows that 93% of returning personnel have completed post-deployment health assessments (submitted to AMSA) and serum samples collected. Some returning personnel have completed health assessments but forms have not yet been submitted to AMSA. Our QA program will ensure that all personnel complete post deployment requirements within 30 days of return. • We estimate that among personnel returning from OIF through May 03, 30% of post deployment assessments utilized the new, enhanced DD Form 2796 with a face-to-face visit with a provider. Subsequent to 21 May 03, all health assessments must be completed utilizing the new process. • Our reports indicate 6% of personnel returning since 1 Mar have required a referral for clinical evaluation.

23. Current Status

24. Automation: PIMR, AFCITA The Road Ahead • Link individual actions and completion dates in PIMR (not just questionaires) • Link Force Protection Prescription products in AFCITA to feed into PIMR (pTabs, atropine, malaria Rx, etc) • Automate Pre/Post Deployment Questionaires in PIMR • GEMS (or son of GEMS): continue to populate with Environmental Data

25. Regulatory Requirements