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Commander's introduction.

Every combat commander's vision of perfection is an effective, sustainable fighting force comprised of healthy, physically fit Warfighters. Obviously there is much work from many, many people working very hard to give that commander what he needs. Among them, the Army Medical Department has one of the most complex of tasks--ensuring the health, physical capabilities and effectiveness, and, ultimately, the survival of the Warfighters themselves. For most people, the concept of Army medicine is the combat medic, medical evacuation helicopters, the combat hospital, and surgeons and nurses working together to save the lives of wounded Warriors. While the remarkable skills and combined efforts of that team represent the pinnacle of immediate, direct, life-saving medical capabilities, that is just one component of the total responsibility that the AMEDD has for each Soldier's health and well-being.

Force health protection is the umbrella term for all we do to keep the Soldier healthy, which essentially involves the consideration of all medical threats to our forces, whether natural or a creation of the enemy. Force health protection is also applicable to nondeployed units and personnel, as medical casualties from diseases, accidents, and, sadly, lifestyle choices represent significant threats to readiness. The Army continues to refine its capabilities in research, planning, application, and resources to address this multifaceted responsibility. A significant example of those efforts is the recent establishment of the Army Public Health Command. This new organization combines Army medicine's public health and preventive medicine resources into a coordinated, focused entity to provide support directly to both garrison and deployed commands, as well as direct high-level research, planning, doctrine development, and data collection and management.

The scope of AMEDD's commitment to force health protection is impossible to convey in a few short paragraphs, or even an entire issue of the AMEDD Journal. Fortunately, over the last four years, COL Mustapha Debboun has regularly assembled articles from preventive medicine and public health professionals for dedicated issues of the Journal, providing true insight to the diversity and complexity of their responsibilities and their work. Those issues have been invaluable sources of information, and this one is no different. The articles in this issue cover the gamut of force health protection concerns, from extensive research studies and surveillance, to solutions for potential threats. As you read this AMEDD Journal, you will be impressed and educated by the breadth and depth of this vital work and vigilance that are never-ending, mostly behind the scenes. Their success is reflected in an absence of disease and injury, and the improved health of us all. For this these medical professionals have truly earned our respect and gratitude, both for what they have done, and what they will do to protect our most valuable asset, the Warriors who defend our nation and our way of life.


The US Army initiated war against mosquito vectors of serious diseases in 1900, when MAJ Walter Reed experimentally proved that yellow fever was indeed transmitted by an identified species of mosquito. That war continues to this day as a mainstay in the efforts of Army public health professionals to identify and control arthropods and other pests that enable the transmission of severely debilitating, often fatal, diseases to humans throughout the world. This issue of the AMEDD Journal contains four articles presenting various aspects of this component of military public health responsibilities. Brian Zeichner and COL Mustapha Debboun contributed an excellent article discussing an innovative, relatively simple idea to control mosquito vectors for two serious diseases that have resurged and expanded over the last several decades. They describe the development of a lure for female mosquitoes seeking an egg-laying site, wherein the mosquito is exposed to an insecticide. Obviously, elimination of the females and their eggs will significantly reduce the number of mosquitoes in the area. The lures are small and inexpensive, requiring only water to activate, and are much safer than sprays or broadcast poisons. This is an interesting, important approach to an age-old problem--another weapon in the public health arsenal to combat mosquito-borne diseases.

COL Leon Robert and CDR Steven Rankin discuss the expanding real-world roles and responsibilities that are placed on military entomologists in today's counterinsurgency and stability operations. Their experience is that the entomologist is involved more than ever before with an assortment of disparate military and government agencies and individuals, as well as nongovernmental international organizations. Beyond that, the entomologist must also be able to work among the de facto power structure in local areas to be effective. Their article discusses these experiences and successes, and offers recommendations as to how to better prepare military entomologists for this reality.

Dr Leopoldo Rueda and his coauthors describe another important role in the battle against vector-borne pathogens. Identification of the different vector species found in areas inhabited by our military is the first step in countering the threat. This article details the work on Guam and neighboring islands to ensure that the data on potentially harmful mosquitoes is as complete as possible. This is especially important in anticipation of the planned significant increase in military and civilian personnel on Guam in the next 5 years.

As with any war, the battle against vector-borne disease requires intelligence, in this case, surveillance records documenting mosquito species, dates, and locations where found. This data is important in planning effective mosquito control programs. The Army began collecting surveillance data for US military installations during World War II. Organized data from 1947 until the present exist and are available online. In their article, Dr Desmond Foley and his coauthors describe the ambitious project they undertook to map the entirety of that data in a state-of-the-art georeferencing system designed specifically for mosquito surveillance. Now the mosquito data can be analyzed within different parameters, including geography, climate, seasons, vegetation types and coverages, among others. Furthermore, this analysis tool may be used by all researchers and planners to develop preventive intervention strategies for mosquito-borne disease threats.

Predictions of the risk of injury are important to force health protection planners. As part of an effort to determine if the risk of lower extremity injuries of Soldiers could be estimated using measurements of endurance, flexibility, strength, and power, LTC Deydre Teyhen and her team had to first assess the reliability and precision of those measurements performed by novice raters. Their article is a thoroughly referenced, detailed report of their measurement procedures, the data collected, and the statistical analysis of the results. This article is an excellent example of the high caliber of medical research and analysis that is the standard for AMEDD professionals.

There are few true absolutes in life, but one of them is that the human body must have water to survive. Unfortunately, water can also transport disease or toxic substances, transforming it into an instrument of sickness and death, often across large populations. Two articles demonstrate how science and engineering collaborate to produce safe, clean water for our Warfighters, both in US garrisons and in deployed environments. In his article, Steven Clarke describes how a waterborne pathogen, Cryptosporidium, was identified in the raw water source for a continental US military facility's water treatment plant. The plant was evaluated and it was determined that improvements in the existing treatment processes were necessary to mitigate the threat. The resulting changes not only substantially reduced the potential risk, but also improved the efficiency and lowered the operating costs of the plant. The other perspective, providing clean water to troops on the battlefield, is presented by Arthur Lundquist and his coauthors. Their article discusses how the evolving nature of modern asymmetric combat operations has seriously complicated the task of getting potable water to dispersed forces, for both engineers and logisticians. This article provides excellent insight into how our multidisciplinary professionals anticipate, identify, and respond to the challenges of today's dynamic combat environment.

CPT Edgie-Mark Co and his coauthors have contributed an article which demonstrates the high level of research and analysis capability we have within AMEDD. Their team sought to identify a better test for specific types of infection-causing organisms which would produce definitive results much more quickly than current laboratory methods in deployed environments. The time saved can be vital, in that the provider can begin targeted antibiotic treatment as soon as the type of infection is identified, rather than guess with broad spectrum antibiotics while additional tests were performed. CPT Co et al's laboratory research found that another, readily available test panel produced expanded test results with higher levels of sensitivity and specificity than the panel currently used. Again, such initiative, skill, and expertise will potentially increase the odds of survival of our wounded Warriors.

MAJ Kent Broussard looks at the challenges that the Army combat organization of today pose for those charged with public health support of deploying units. The integration and coordination of 5 levels of support across the 3 phases of a deployment cycle can be daunting tasks, requiring significant organizational skills, attention to detail, and, ideally, some level of experience in deployments. This article itemizes the doctrinal responsibilities of the public health resources that are involved, and illustrates the complexity of such an enterprise. It is a good synopsis of the commitment of the Army healthcare system to force health protection of our deploying forces.

The AMEDD Journal welcomes Dr Coleen Baird back to these pages with another excellent article addressing concerns about the respiratory health of deployed personnel, both during and following deployments to combat theaters. There is a growing concern in the medical community about the relationship between deployments and respiratory problems, and in this issue, Dr Baird examines the available data on that possible linkage, and discusses the ongoing efforts to improve the quality of the data gathered, and refine the assessments. Her article provides an important insight for healthcare providers involved with evaluating and treating respiratory problems among our deploying military and civilian personnel.

Evaluation of long term health effects (other than traumatic injury) of the combat environment are difficult to perform, in that the parameters are difficult to establish and quantify, and the target population is often dispersed and affected by unrelated factors. Dr Hikmet Jamil and his coauthors designed and performed a study in 2002 to examine the native population, civilian and military, who lived and/or served in the war zone of the 1991 Gulf War. Their article describes their extensive study, presents the analyzed data, and evaluates the results. Their accumulated data had to be examined from numerous perspectives and statistical categories, and carefully analyzed to account for nonrelevant influences or corrupting factors. This is an excellent presentation of a study which had to be carefully designed and conducted to examine a large, complex set of possible elements and circumstances.

One of the tenets of our military of is that "we train as we fight." Combat training has developed the most realistic environments possible, and our combat Warriors are placed in those environments time and again to experience every conceivable scenario and situation. Of course safety is paramount, but combat operations are risky, and the training can be as well. However, the combat effectiveness of a fighting force can be compromised by injuries to Warfighters during training, especially if such injuries are not obvious. Hearing and vestibular damage are often subtle, but can be cumulative, and can be a dangerous disadvantage in combat. Dr Paul St. Onge and his team of researchers examined a training evolution in which the trainees and instructors are repeatedly exposed to explosions in close proximity, often in closed spaces. All participants are trained and equipped with hearing protection, but the particular circumstances of this training environment are unique, and the effects had not been scientifically evaluated. This important article describes the detailed design and careful execution of the study, as well as the evaluation and interpretation of the resulting data. It is another excellent example of the level of expertise and skills that our medical professionals bring to work every day.

Starting and maintaining any type of exercise program is usually more of a psychological effort than actual physical work. Many ideas about ways to turn normal functions into useful exercise have come and gone, probably because they are easily forgotten. CPT Mary Staudter and her team conducted a study with staff members at Brooke Army Medical Center to examine if use of a pedometer and tracking step counts could encourage more exercise with simple increased walking in their normal daily activities. Other studies had indicated that this can be the case, and this study looked at such use of pedometers among the select population of military healthcare providers and their families. Their article describes this carefully designed, meticulously conducted study, presents the details of the statistical data analysis, and discusses the results, and the complications to any conclusions that may be derived. All readers should find this article informative and instructive, and perhaps an inspiration to consider such a program for themselves.
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Title Annotation:Perspectives
Author:Rubenstein, David A.
Publication:U.S. Army Medical Department Journal
Article Type:Report
Geographic Code:1USA
Date:Jul 1, 2011
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