DVIDS – News – Military public health experts offer suggestions to leaders for improving medical preparedness

by V. Hauschild, MPH, Defense Center for Public Health-Aberdeen
ABERDEEN PROVING GROUND, Md. — For more than a decade, military medical surveillance data analyzed by the Army Public Health Center, now the Defense Center for Public Health-Aberdeen, has shown the same two major drivers of seeking medical care by soldiers. Causes identified:

• Outpatient visits for injuries, especially overuse injuries of bone and soft tissue of the musculoskeletal system, and

• Health care for behavioral health conditions including adjustment disorders, depressive disorders, substance abuse, post-traumatic stress disorder, anxiety disorders and sleep disorders.

[Figure 1]
Army statistics repeatedly show that the number of soldiers affected by injuries and behavioral health conditions exceeds that for all other groups of medical conditions combined.

“These conditions not only require multiple clinical visits for treatment, but are also profiled for more days of limited duty than all other medical conditions combined,” Dr. Bruce Jones, a medical doctor and retired Army colonel who is now senior injury scientist. DCPH-A. “Temporary profiles for injuries and behavioral health conditions can affect readiness to deploy.”

Army data shows that nearly one in five soldiers may not be mission ready due to temporary medical profiles resulting from injuries or behavioral health conditions.

The Army’s 2020 Health of the Force report, also known as the HOF, found musculoskeletal, or MSK, injuries such as overuse injuries resulted in an average loss of more than two months or limited duty time per injury. Behavioral health conditions require an average of about three months of lost or restricted duty per Soldier receiving care.

“Reducing the severity or impact of injuries and behavioral conditions on soldiers’ health can enhance a unit’s medical preparedness and fighting ability,” says Army Colonel Mark Reynolds, director of the DCPH-A Clinical and Epidemiology Directorate.

Reynolds and other CPHE health experts recommend commanders and leaders optimize their unit’s health with the following tips:

Tip 1. Be a more active and engaged leader
Leading by example and keeping in touch with soldiers is the first step towards maximizing unit strength.

According to a 2016 APHC study, less than half of soldiers surveyed felt that leadership prioritized injury prevention and made them aware of major injuries and risk factors. He felt that many leaders were unaware of the magnitude of the adverse effects of injury to the military, and/or did not know what they as leaders could do to reduce these injuries.

According to one respondent the report noted, “It is imperative to change the mindset of injury within the military. … It starts with drill sergeants who do not want to appear vulnerable in front of their trainees and progresses through Huh [Chain of Command],

Another respondent, a medical provider, said, “Leaders … play a direct role in helping junior soldiers recover from and recover from injury … For example, I treat a patient with an ankle fracture.” He is in a cast and on crutches yet was made to walk for PT.

Inconsistent leadership support or awareness has also been reported as a barrier to soldiers seeking and continuing to seek behavioral health care. According to DCPH-A, while behavioral health stigma has decreased over the past decade, soldiers continue to report fear that they will be perceived as vulnerable as a result of engaging in behavioral health care.

“It’s important for leaders to ensure good nutrition, quality sleep, adequate exercise, and not abusing substances or smoking,” says Reynolds. health care resources. ,

Tip 2. Know the reasons for your unit’s lack of medical preparedness

Personal medical readiness contributes directly to mission success. Leaders must ensure that soldiers are up to date on annual medical requirements, including periodic health assessments, dental and eye exams, bloodwork and vaccinations.

But being up to date on medical exams is not the only reason why a unit is not medically ready. Injuries and behavioral conditions from overuse of soldiers can also reduce a unit’s capabilities.

Unit leaders should be aware that these health conditions can put soldiers out of commission for weeks. Leaders can monitor profiles and should talk with profiling healthcare providers to learn how to aid recovery and prevent recurrence.

According to Jones, some have argued that medical treatment for soldiers’ injuries and behavioral conditions, and the associated temporary profiles, are a “cost of doing business”.

“But it’s not true,” he says. “Identification of a unit’s greatest health problems or increasing trends in health status may lead to meaningful modification of training activities or an increase in a unit’s use of local wellness resources.”

For example, APHC data shows that most soldiers’ MSK injuries include soft tissue pain and swelling, hallmarks of overuse injuries. Overuse injuries of the knee, followed by the lower back, ankle and foot result in the most lost or restricted duty days. In men, shoulder injuries also limit duty for extended periods, while hip injuries are a problem in women.

These injuries are often caused by repetitive training activities such as running or ruck marches, says Jones.
“But while these are a necessary part of military training, injury rates that are higher than average or increasing over time may indicate that a unit is overtraining,” Jones says.

Indicators of overtraining suggest a need to revise training regimens. Examples of overtraining include excessive or too rapid increases in distances, or a lack of lower-body recovery days between activities such as running and ruck marching.

Tip 3. Monitor your unit’s health and fitness status

Leaders document and monitor their unit’s fitness test results, body composition data and profiles in the Army’s digital training management system.

“If a unit’s physical fitness is declining over time—and injury rates are increasing—that’s a major sign that the unit is overtraining,” says Jones.

“Each entity may have unique health conditions or risk factors that affect preparation,” says Jones. “Commanders can use information on their unit’s health, physical fitness and training to identify existing or emerging risks in order to target specific threats for prevention.”

Tip 4. Adjust training programs and strategies to optimize physical health

To ensure combat readiness, military policy directs commanders to maintain and enhance soldiers’ physical fitness and health habits. For example, Field Manual (FM) 7-22, Overall Health and Fitness, provides guidance for leaders on how to develop and maintain the physical fitness and health of soldiers.

The basics of overall health include ensuring healthy eating and managing weight, optimizing sleep and providing quality sleep conditions, and balancing physical training to reduce injuries.

Jones notes that employing recommended strategies that enhance physical fitness and also reduce the incidence of injuries should be among a leader’s priorities.

[Figure 2]
The DCPH-A provides a risk management tool customized to reflect the health and fitness policy, as well as guidance that can assist unit leaders or designated employees in assessing the quality and comprehensiveness of their fitness and health programs.

Tip 5. Strengthen Mental Resilience

APHC studies have found relationship problems or a family death, substance abuse, and difficulty sleeping are key features associated with suicide. While these life stressors may not be unique to service members, they can be exacerbated by military life.

Leaders can help soldiers by reminding them that the military doesn’t expect them to be bulletproof. Leaders should encourage soldiers to seek practical help just as they should use protective equipment to protect themselves from injury.

DCPH-A behavioral health experts advise leaders to be on the lookout for soldiers who may benefit from behavioral health counseling, and not to deter those seeking help.

Tip 6. Use your local experts and reach-back support

The strength of a military unit reflects the physical and mental resilience of individual soldiers.

Leaders have a lot of responsibility and are usually not health experts; However, he has many resources at his disposal. Commanders must use data on the physical and behavioral health and fitness of their soldiers to identify health and fitness problems and make decisions about how to address them.

The military public health system includes medical, public health, fitness, nutrition, and behavioral subject matter expertise at the local, regional, and service levels.

Check with local aid organizations first. For information about your local setting, see the Community Resource Guide. Installation and field support includes –

• Local Preventive Medicine and Public Health Nurse Aides
• Unit Master Fitness Trainer: https://phc.amedd.army.mil/PHC Resource Library/cphe-inp-leader-tool-health-and-fitness-risk.pdf
• Army Wellness Center (Healthy living specialist for fitness, nutrition, stress)
• Army Chaplain, Unit Ministry Team, Unit Behavioral Health Officer, and Military and Family Life Counselor

For DCPH-A guidance regarding mitigating injuries, see https://phc.amedd.army.mil/topics/discond/ptsaip/Pages/default.aspx for the following

• Military Injury Prevention Resources
Leader’s risk matrix tool for unit health and fitness,
• Commander’s Guide to Preventing MSK Injuries
• Injury Prevention Fact Sheet.

Recommendations about improving behavioral health problems can be found in the APHC’s Commander’s Guide to Suicide Prevention.

The Defense Center for Public Health-Aberdeen advances joint force health security with agile public health enterprise solutions that support our nation by improving health and building readiness – making extraordinary experiences ordinary and extraordinary outcomes routine.

Note: Mention of any non-federal entity and/or its products is for informational purposes only, and should not be construed or interpreted in any way as a federal endorsement of that non-federal entity or its products needed.

date taken: 01.24.2023
Date Posted: 01.24.2023 11:13
Story ID: 437147
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