The Army physician assistant (PA) has an important role throughout Army medicine. This handbook will describe the myriad positions and organizations in which PAs play leadership roles in management and patient care. Chapters also cover PA education, certification, continuing training, and career progression. Topics include the Interservice PA Program, assignments at the White House and the Old Guard (3d US Infantry Regiment), and roles in research and recruiting, as well as the PA's role in emergency medicine, aeromedical evacuation, clinical care, surgery, and occupational health. More titles produced by the US Army, Borden Institute can be found here: https://bookstore.gpo.gov/agency/borden-institute Check out our Healthcare Teamwork & Patient Safety resources collection here: https://bookstore.gpo.gov/catalog/healthcare-teamwork-patient-safety-teamstepps Best Care Everywhere can be found here: https://bookstore.gpo.gov/products/best-care-everywhere
The official, comprehensive, and widely used U.S. Army "Emergency War Surgery" handbook addresses the appropriate medical management of both battle and non-battle injuries. A collaborative effort of the Borden Institute and the Walter Reed Army Medical Center, the text is an essential tool for the management of forward combat trauma.
The Army physician assistant (PA) has an important role throughout Army medicine. This handbook will describe the myriad positions and organizations in which PAs play leadership roles in management and patient care. Chapters also cover PA education, certification, continuing training, and career progression. Topics include the Interservice PA Program, assignments at the White House and the Old Guard (3d US Infantry Regiment), and roles in research and recruiting, as well as the PA’s role in emergency medicine, aeromedical evacuation, clinical care, surgery, and occupational health. More titles produced by the US Army, Borden Institute can be found here: https://bookstore.gpo.gov/agency/borden-institute Check out our Healthcare Teamwork & Patient Safety resources collection here: https://bookstore.gpo.gov/catalog/healthcare-teamwork-patient-safety-teamstepps Best Care Everywhere can be found here: https://bookstore.gpo.gov/products/best-care-everywhere
The Army physician assistant (PA) has an important role throughout Army medicine. This handbook will describe the myriad positions and organizations in which PAs play leadership roles in management and patient care. Chapters also cover PA education, certification, continuing training, and career progression. Topics include the Interservice PA Program, assignments at the White House and the Old Guard (3d US Infantry Regiment), and roles in research and recruiting, as well as the PA’s role in emergency medicine, aeromedical evacuation, clinical care, surgery, and occupational health. More titles produced by the US Army, Borden Institute can be found here: https://bookstore.gpo.gov/agency/borden-institute Check out our Healthcare Teamwork & Patient Safety resources collection here: https://bookstore.gpo.gov/catalog/healthcare-teamwork-patient-safety-teamstepps Best Care Everywhere can be found here: https://bookstore.gpo.gov/products/best-care-everywhere
The indoor environment affects occupants' health and comfort. Poor environmental conditions and indoor contaminants are estimated to cost the U.S. economy tens of billions of dollars a year in exacerbation of illnesses like asthma, allergic symptoms, and subsequent lost productivity. Climate change has the potential to affect the indoor environment because conditions inside buildings are influenced by conditions outside them. Climate Change, the Indoor Environment, and Health addresses the impacts that climate change may have on the indoor environment and the resulting health effects. It finds that steps taken to mitigate climate change may cause or exacerbate harmful indoor environmental conditions. The book discusses the role the Environmental Protection Agency (EPA) should take in informing the public, health professionals, and those in the building industry about potential risks and what can be done to address them. The study also recommends that building codes account for climate change projections; that federal agencies join to develop or refine protocols and testing standards for evaluating emissions from materials, furnishings, and appliances used in buildings; and that building weatherization efforts include consideration of health effects. Climate Change, the Indoor Environment, and Health is written primarily for the EPA and other federal agencies, organizations, and researchers with interests in public health; the environment; building design, construction, and operation; and climate issues.
Being deployed to a war zone can result in numerous adverse psychological health conditions. It is well documented in the literature that there are high rates of psychological disorders among military personnel serving in Operation Enduring Freedom in Afghanistan and Operation Iraqi Freedom in Iraq as well as among the service members' families. For service members' families, the degree of hardship and negative consequences rises with the amount of the service members' exposure to traumatic or life-altering experiences. Adult and child members of the families of service members who experience wartime deployments have been found to be at increased risk for symptoms of psychological disorders and to be more likely to use mental health services. In an effort to provide early recognition and early intervention that meet the psychological health needs of service members and their families, DOD currently screens for many of these conditions at numerous points during the military life cycle, and it is implementing structural interventions that support the improved integration of military line personnel, non-medical caregivers, and clinicians, such as RESPECT-Mil (Re-engineering Systems of Primary Care Treatment in the Military), embedded mental health providers, and the Patient-Centered Medical Home. Preventing Psychological Disorders in Service Members and Their Families evaluates risk and protective factors in military and family populations and suggests that prevention strategies are needed at multiple levels - individual, interpersonal, institutional, community, and societal - in order to address the influence that these factors have on psychological health. This report reviews and critiques reintegration programs and prevention strategies for PTSD, depression, recovery support, and prevention of substance abuse, suicide, and interpersonal violence.
Posttraumatic stress disorder (PTSD) is one of the signature injuries of the U.S. conflicts in Afghanistan and Iraq, but it affects veterans of all eras. It is estimated that 7-20% of service members and veterans who served in Operation Enduring Freedom and Operation Iraqi Freedom may have the disorder. PTSD is characterized by a combination of mental health symptoms - re-experiencing of a traumatic event, avoidance of trauma-associated stimuli, adverse alterations in thoughts and mood, and hyperarousal - that last at least 1 month and impair functioning. PTSD can be lifelong and pervade all aspects of a service member's or veteran's life, including mental and physical health, family and social relationships, and employment. It is often concurrent with other health problems, such as depression, traumatic brain injury, chronic pain, substance abuse disorder, and intimate partner violence. The Department of Defense (DoD) and the Department of Veterans Affairs (VA) provide a spectrum of programs and services to screen for, diagnose, treat for, and rehabilitate service members and veterans who have or are at risk for PTSD. The 2010 National Defense Authorization Act asked the Institute of Medicine to assess those PTSD programs and services in two phases. The Phase 1 study, Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Initial Assessment, focused on data gathering. Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations Final Assessment is the report of the second phase of the study. This report analyzes the data received in Phase 1 specifically to determine the rates of success for each program or method. Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations Final Assessment considers what a successful PTSD management system is and whether and how such a system is being implemented by DoD and VA. This includes an assessment of what care is given and to whom, how effectiveness is measured, what types of mental health care providers are available, what influences whether a service member or veteran seeks care, and what are the costs associated with that care. This report focuses on the opportunities and challenges that DoD and VA face in developing, implementing, and evaluating services and programs in the context of achieving a high-performing system to care for service members and veterans who have PTSD. The report also identifies where gaps or new emphases might be addressed to improve prevention of, screening for, diagnosis of, and treatment and rehabilitation for the disorder. The findings and recommendations of Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations: Final Assessment will encourage DoD and VA to increase their efforts in moving toward a high-performing, comprehensive, integrated PTSD management strategy that addresses the needs of current and future service members, veterans, and their families.
More than 3.7 million U.S. service members have participated in operations taking place in the Southwest Asia Theater of Military Operations since 1990. These operations include the 1990-1991 Persian Gulf War, a post-war stabilization period spanning 1992 through September 2001, and the campaigns undertaken in the wake of the September 11, 2001, attacks. Deployment to Iraq, Kuwait, Saudi Arabia, Bahrain, Gulf of Aden, Gulf of Oman, Oman, Qatar, the United Arab Emirates, and Afghanistan exposed service members to a number of airborne hazards, including oil-well fire smoke, emissions from open burn pits, dust and sand suspended in the air, and exhaust from diesel vehicles. The effects of these were compounded by stressors like excessive heat and noise that are inevitable attributes of service in a combat environment. Respiratory Health Effects of Airborne Hazards Exposures in the Southwest Asia Theater of Military Operations reviews the scientific evidence regarding respiratory health outcomes in veterans of the Southwest Asia conflicts and identifies research that could feasibly be conducted to address outstanding questions and generate answers, newly emerging technologies that could aid in these efforts, and organizations that the Veterans Administration might partner with to accomplish this work.
Nearly 1.9 million U.S. troops have been deployed to Afghanistan and Iraq since October 2001. Many service members and veterans face serious challenges in readjusting to normal life after returning home. This initial book presents findings on the most critical challenges, and lays out the blueprint for the second phase of the study to determine how best to meet the needs of returning troops and their families.
Advances in trauma care have accelerated over the past decade, spurred by the significant burden of injury from the wars in Afghanistan and Iraq. Between 2005 and 2013, the case fatality rate for United States service members injured in Afghanistan decreased by nearly 50 percent, despite an increase in the severity of injury among U.S. troops during the same period of time. But as the war in Afghanistan ends, knowledge and advances in trauma care developed by the Department of Defense (DoD) over the past decade from experiences in Afghanistan and Iraq may be lost. This would have implications for the quality of trauma care both within the DoD and in the civilian setting, where adoption of military advances in trauma care has become increasingly common and necessary to improve the response to multiple civilian casualty events. Intentional steps to codify and harvest the lessons learned within the military's trauma system are needed to ensure a ready military medical force for future combat and to prevent death from survivable injuries in both military and civilian systems. This will require partnership across military and civilian sectors and a sustained commitment from trauma system leaders at all levels to assure that the necessary knowledge and tools are not lost. A National Trauma Care System defines the components of a learning health system necessary to enable continued improvement in trauma care in both the civilian and the military sectors. This report provides recommendations to ensure that lessons learned over the past decade from the military's experiences in Afghanistan and Iraq are sustained and built upon for future combat operations and translated into the U.S. civilian system.
Traumatic brain injury (TBI) accounts for up to one-third of combat-related injuries in Iraq and Afghanistan, according to some estimates. TBI is also a major problem among civilians, especially those who engage in certain sports. At the request of the Department of Defense, the IOM examined the potential role of nutrition in the treatment of and resilience against TBI.
The influenza pandemics of 1918, 1957, and 1968 offer a warning to the world about the potential dangers of the influenza virus. In 2006, after a series of cases and clusters of the highly pathogenic H5N1 avian virus made clear the threat of a possible pandemic, the U.S. Congress allocated $39 million to the Department of Defense Global Emerging Infections Surveillance and Response System (DoD-GEIS) to increase and improve its worldwide influenza surveillance network through upgrades to its domestic and overseas laboratories' capabilities. An Institute of Medicine (IOM) committee was subsequently formed to evaluate the effectiveness of these laboratory-based programs in relation to the supplemental funding, and the report that follows details the committee's findings. The committee that prepared this report, the Committee for the Assessment of DoD-GEIS Influenza Surveillance and Response Programs, was convened at the request of DoD-GEIS management to evaluate the execution of the fiscal year 2006 supplemental funding for avian influenza/ pandemic influenza (AI/PI) surveillance and response. The committee was tasked with evaluating the DoD-GEIS AI/PI surveillance program for the worth of each funded project's contribution to a comprehensive AI/PI surveillance program; the adequacy of the program in view of the evolving epidemiologic factors; responsiveness to the intent of Congress as expressed in Sec. 748, H.R.1815, Pandemic Avian Flu Preparedness; consistency with the DoD and national plans; and coordination of efforts with CDC, WHO, and local governments. Review of the DoD-GEIS Influenza Programs: Strengthening Global Surveillance and Response reviews the development of conclusions and recommendations with long-term, program-level relevance as well as conclusions and recommendations regarding the improvement of specific DoD-GEIS projects.
Military operations produce a great deal of trash in an environment where standard waste management practices may be subordinated to more pressing concerns. As a result, ground forces have long relied on incineration in open-air pits as a means of getting rid of refuse. Concerns over possible adverse effects of exposure to smoke from trash burning in the theater were first expressed in the wake of the 1990â€"1991 Gulf War and stimulated a series of studies that indicated that exposures to smoke from oil-well fires and from other combustion sources, including waste burning, were stressors for troops. In January 2013, Congress directed the Department of Veterans Affairs (VA) to establish and maintain a registry for service members who may have been exposed to toxic airborne chemicals and fumes generated by open burn pits. Assessment of the Department of Veterans Affairs Airborne Hazards and Open Burn Pit Registry analyzes the initial months of data collected by the registry and offers recommendations on ways to improve the instrument and best use the information it collects. This report assesses the effectiveness of the VA's information gathering efforts and provides recommendations for addressing the future medical needs of the affected groups, and provides recommendations on collecting, maintaining, and monitoring information collected by the VA's Airborne Hazards and Open Burn Pit Registry.
Soldiers deployed during the 1991 Persian Gulf War were exposed to high concentrations of particulate matter (PM) and other airborne pollutants. Their exposures were largely the result of daily windblown dust, dust storms, and smoke from oil fires. On returning from deployment, many veterans complained of persistent respiratory symptoms. With the renewed activity in the Middle East over the last few years, deployed military personnel are again exposed to dust storms and daily windblown dust in addition to other types of PM, such as diesel exhaust and particles from open-pit burning. On the basis of the high concentrations observed and concerns about the potential health effects, DOD designed and implemented a study to characterize and quantify the PM in the ambient environment at 15 sites in the Middle East. The endeavor is known as the DOD Enhanced Particulate Matter Surveillance Program (EPMSP). The U.S. Army asked the National Research Council to review the EPMSP report. In response, the present evaluation considers the potential acute and chronic health implications on the basis of information presented in the report. It also considers epidemiologic and health-surveillance data collected by the USACHPPM, to assess potential health implications for deployed personnel, and recommends methods for reducing or characterizing health risks.
The U.S. military has been continuously engaged in foreign conflicts for over two decades. The strains that these deployments, the associated increases in operational tempo, and the general challenges of military life affect not only service members but also the people who depend on them and who support them as they support the nation â€" their families. Family members provide support to service members while they serve or when they have difficulties; family problems can interfere with the ability of service members to deploy or remain in theater; and family members are central influences on whether members continue to serve. In addition, rising family diversity and complexity will likely increase the difficulty of creating military policies, programs and practices that adequately support families in the performance of military duties. Strengthening the Military Family Readiness System for a Changing American Society examines the challenges and opportunities facing military families and what is known about effective strategies for supporting and protecting military children and families, as well as lessons to be learned from these experiences. This report offers recommendations regarding what is needed to strengthen the support system for military families.
Research in veterinary science is critical for the health and well-being of animals, including humans. Food safety, emerging infectious diseases, the development of new therapies, and the possibility of bioterrorism are examples of issues addressed by veterinary science that have an impact on both human and animal health. However, there is a lack of scientists engaged in veterinary research. Too few veterinarians pursue research careers, and there is a shortage of facilities and funding for conducting research. This report identifies questions and issues that veterinary research can help to address, and discusses the scientific expertise and infrastructure needed to meet the most critical research needs. The report finds that there is an urgent need to provide adequate resources for investigators, training programs, and facilities involved in veterinary research.
This report reviews the implications of heat stress in working environments in agriculture (with a focus on farming and forestry), how it affects the human body, the risks it poses to human health, how it is measured, how it affects labour productivity, and how it can be managed. Managers often disregard heat stress as an occupational hazard, and workers therefore often have to handle this aspect of the work environment themselves. Heat stress has a negative effect on worker performance, and exposure to severe heat stress can be fatal; nevertheless, it can be greatly reduced with proper work organization and education.
Combat helmets have evolved considerably over the years from those used in World War I to today's Advanced Combat Helmet. One of the key advances was the development of aramid fibers in the 1960s, which led to today's Kevlar-based helmets. The Department of Defense is continuing to invest in research to improve helmet performance, through better design and materials as well as better manufacturing processes. Review of the Department of Defense Test Protocols for Combat Helmets considers the technical issues relating to test protocols for military combat helmets. At the request of the DOD Director of Operational Test and Evaluation, this report evaluates the adequacy of the Advanced Combat Helmet test protocol for both first article testing and lot acceptance testing, including its use of the metrics of probability of no penetration and the upper tolerance limit (used to evaluate backface deformation). The report evaluates appropriate use of statistical techniques in gathering data; adequacy of current helmet testing procedures; procedures for the conduct of additional analysis of penetration and backface deformation data; and scope of characterization testing relative to the benefit of the information obtained.
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