2 April 2010

1. Force Health Protection and Readiness Overview Briefing to the Institute for Defense & Government Advancement Colonel Donald Noah, DVM, MPH Acting Deputy Assistant Secretary of Defense Force Health Protection and Readiness 2 April 2010

2. Force Health Protection* Shape defense-wide health care and deployment medical support capabilities to improve, protect, and conserve the health and resilience of Service members for optimal mission performance across global military activities and operations. * Joint FHP CONOPS

3. Health Affairs Command Structure Secretary of Defense Robert Gates Under Secretary of Defense Personnel & Readiness Clifford Stanley (A) Assistant Secretary of Defense Health Affairs Charles Rice DASD Force Health Protection & Readiness Col Donald Noah DASD Clinical & Program Policy DASD Health Budgets & Financial Policy Strategic Communications Director DASD Health Policy Administration Chief Information Officer

4. SecDef DepSecDef Organizational Relationships CJCS USD (P&R) Military Departments Joint Chiefs of Staff ASD (HA) CINCs Service Surgeons General TMA JTF CapMed TRICARE Regional Offices

5. FHP&R/FHP&RP Functional Chart

6. Key Duties & Responsibilities Principal staff assistant for all DoD deployment medicine and force health protection and medical readiness policies, programs, and activities Responsible for theater information systems, health and medical surveillance, international agreements, and health care policies in support of contingency operations Manages the DoD portion of the National Disaster Medical System (NDMS) Collaborates and cooperates with the Department of Veterans Affairs (VA)

7. FHP&R Program Directorates Responsible for military health care policy… • Executive Support & Program Integration • Civil – Military Medicine • Force Readiness and Health Assurance • Deployment Technologies and Support Programs • Defense Health Program/ Medical Research and Development • Operational Medicine and Medical Force Readiness • International Health • Medical Countermeasures • Psychological Health

8. Civil-Military Medicine Ensures that the MHS provides the highest possible quality of health service support to military missions related to homeland defense, support to civil authorities, and emergency preparedness & response Develops policies and oversees programs for MHS support to: Disasters, mass casualty events and public health emergencies (PHEOs) Critical infrastructure and installation protection Continuity of Operation and Crisis Management Integrated laboratory response (Defense Laboratory Network) Interacts with other DoD components, other federal departments, the White House National/Homeland Security Council, and state and local governments Influenza – H1N1 Coordination

9. National Response Framework • Purpose • Guides how the nation conducts all-hazards • incident response. • Key Concepts • Builds on the National Incident Management System (NIMS) with its flexible, scalable, and adaptable coordinating structures. • Aligns key roles and responsibilities across jurisdictions. • Links all levels of government, private sector, and nongovernmental organizations in a unified approach to emergency management. • Always in effect: can be partially or fully implemented. • Coordinates Federal assistance without need for formal trigger.

10. Strategy for Homeland Defense and Civil Support Improve national and international capabilities for homeland defense and homeland security Support civil authorities in minimizing and recovering from domestic CBRNE catastrophes/mass casualty attacks

11. Pandemic Influenza Preparedness National Strategy for Pandemic Influenza 114 of 323 Tasks assigned to DoD (31 Lead, 83 Support) OASDHA with 21 of 31 Lead Tasks, 53 of 83 Support Tasks Support tasks include: surge capacity, risk communication, laboratory diagnostics, countermeasures, surveillance, disease containment

12. Laboratory-Based Influenza Surveillance Sentinel* Surveillance (MTF-based) US Air Force School of Aerospace Medicine (Brooks City Base, TX) European Region, LRMC and USACHPPM-Europe Population-based Surveillance (troop-based) Navy Health Research Center (San Diego, California) International Surveillance (host country populations-military and civilian) NAMRU-2 (Jakarta, Indonesia) NAMRU-3 (Cairo, Egypt) NMRCD (Lima, Peru) AFRIMS (Bangkok, Thailand) USAMRU-K (Nairobi, Kenya) *Sentinel labs are those labs committed to notify CDC of reportable conditions/diseases

13. The purpose of the National Disaster Medical System (NDMS) is to: support our nation’s military medical system, by caring for casualties who are evacuated back to the United States that result from a conventional armed conflict fought overseas. help state and local authorities cope effectively with medical consequences resulting from major domestic disasters. National Disaster Medical System

14. NDMS Partnership HHS: Provides Response Teams VA: Provides Definitive Care DOD: Provides Patient MovementDefinitive Care DHS: Provides Disaster Funding

15. Force Readiness and Health Assurance • Develops policies and programs that protect and optimize the health and safety of Service members and their families during all phases of deployment • FR&HA focuses on four main areas: • Individual Medical Readiness • Health Assessments • Preventive Medicine • Environmental Health • Force Optimization • Global Health Surveillance

16. Active Component Q1 FY09

17. Reserve Component Q1 FY09

18. Current Health Assessments Periodic Health Assessment (PHA) Pre-Deployment Health Assessment Post-Deployment Health Assessment Post-Deployment Health Reassessment

19. Reserve Health Readiness Program • The RHRP provides medical and dental services to all Reserve Component forces including the Coast Guard • Services include physical exams, Periodic Health Assessments (PHA), dental exams, X-Rays, blood draws, immunizations, vision/audio screenings, PDHA/PDHRAs, and Individual Medical Readiness (IMR) services for Active Duty Service members located in geographically remote areas • Services are provided through three channels: Civilian clinics for individual appointments Onsite at unit locations to perform multiple services Call Center (PHA, augmenting in-clinic & PDHA/PDHRA) • As of today, 586,450 Service members have received services. The current network of active, licensed health care providers is 7,600 – Service members also utilize 12,900 provider offices

20. Disease & Injuries (D&I) CENTCOM (OEF/OIF) Combined Percent of all Encounters Cumulative Last 3 Mos Injuries, all types 22% 20% Mental Health 9% 10% Dermatologic 7% 5% Influenza-like Illness 5% 5% Upper Respiratory 1% 1% Gastrointestinal 2% 2% All other categories 45% 49% TOTAL ENCOUNTERS 2,403,966 209,236 Data Source: Theater Medical Data Store (TMDS) 01 JAN 05 to 31 Dec 09 Analysis by: Armed Forces Health Surveillance Center

21. Distribution by Underlying Condition: Disease 60% Non-Battle Injury 21% Battle Injury 19% Medical Air Transports from CENTCOM for OEF/OIF Total Number of Individuals Transported: 57,584 Data Source: USTRANSCOM TRAC2ES As of 5 January 2010 Analysis by: Armed Forces Health Surveillance Center

22. Deployment Technologies andSupport Programs • Operational Health Support Systems and Technologies • Deployment Health Technology Support • Deployment Health Data Systems • Deployment Medical Records Management • System and Communications Contingency Operations Planning • Correspondence, Security, Contract, Space and Travel Management • Communications Technologies

23. DHP – Medical Research and Development Develops policy and oversees health research and clinical investigations conducted under the Defense Health Program Component Clinical Investigation Programs Congressionally Directed Medical Research Program USD(P&R) Human Research Protection Program • Hardware • Software • Pharmaceuticals • Biologics • Surgical methods

24. Operational Medicine and Medical Force Readiness • Capability Area Management • Medical Logistics • Theater Trauma Management • Joint Theater Trauma System and Registry • Enroute Care Policies and Programs • Blast Injury Management • Traumatic Brain Injury Management • Forward Resuscitative Care • Theater Medical Records • Operations Medical Force Requirements Planning

25. International Health • Medical Stability Operations • Works with U.S. non-government agencies and foreign governments to improve health conditions and enhance stability worldwide • Humanitarian Assistance and Disaster Relief • Provides situational analysis, assistance and relief effort coordination and resourcing • International Health • Assists developing countries to build their health sectors • Fosters long-term stability and sustainability

26. Medical Countermeasures Develops policies and programs to advance health protection for U.S. forces against CBRN threat agents Provides advice on significant new biomedical defense strategies and the scientific, health and regulatory aspects of medical measures Ensures the Military Health System is prepared to treat any illness or deteriorating health conditions resulting from a Warfighter’s exposure to CBRN agents Cooperates with DoD partners on influenza and other disease surveillance activities - www.dod.mil/pandemicflu

27. Psychological Health Develops policies and programs that promote psychological health and resiliency, and foster mental well being in Service members, their families, and their communities Program strives to achieve its mission through – • Readiness: Maintain a Psychologically Health and Resilient Force (Improve deployment-related health assessments) • Protection: Ensure policies are in place to ease the psychological burden on Service members (Stress Control policies, inTransition) • Prevention: Reducing stress in Service members and families (Military Pathways, Psychological Health Demo projects) • Proponency: Providing advocacy and support (Recruiting and retaining military mental health providers)

28. Federal Response Requirements Capability Gap State Response Capability Gap Local Response Disaster Response Level of effort Time after onset of disaster

29. Federal Response Requirements Resilience State Response Capability Gap Local Response Psychological Health Level of effort Time after onset of disaster

30. Five frogs are sitting on a log. Four decide to jump off. How many are left? Frogs on a Log…

31. Frogs on a Log… FIVE

32. There is a difference between deciding and doing. Frogs on a Log…

33. Semper Gumby