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Post-Deployment Health a DoD Priority

By Sgt. 1st Class Kathleen T. Rhem, USA
American Forces Press Service

WASHINGTON, Jan. 30, 2002 – DoD officials believe caring for service members after a deployment should be a national priority. They've taken the lessons learned since the Gulf War and devised a set of guidelines for healthcare professionals to care for service members with deployment- related health concerns.

Beginning March 1, healthcare providers will ask service members who seek medical care if their visit is related to concerns stemming from a deployment.

"We're not necessarily asking patients to make a diagnostic call and tell us whether their disease or ailment is caused by that deployment," said Army Lt. Col. (Dr.) Charles Engel, "but is that part of the concern that's driving their care that day?"

Engel is the director of DoD's Deployment Health Clinical Center at Walter Reed Army Medical Center here. He also serves as the DoD consultant for the new clinical practice guidelines.

If the service member answers, "yes," the new guidelines require the provider to take certain steps, including a specific evaluation and arrange follow-up visits. Engel said patients receiving routine check-ups or wellness visits would not be asked the deployment question.

After the 1990-1991 Gulf War, DoD realized veterans were suffering from unexplained health problems, typified by fatigue, diffuse pain, and sleep and memory problems, Engel explained.

He said DoD officials have come to realize deployment- related health conditions may not show up during or immediately after a deployment.

"A certain proportion of people return (from deployments with) valid and real physical symptoms, and unfortunately diagnostic testing doesn't give us the exact answer as to what their disease is or ailment is," Engel said. "And what we have found after the Gulf War is that even 10 years later, the best science doesn't give us a discreet answer as to what exposure on the battlefield may be responsible for this."

However, he said, DoD medical professionals are trying to do a better job of acknowledging patients' concerns than has been done in the past. That's where the Clinical Practice Guideline for Post-Deployment Health Evaluation and Management comes in.

"Part of what the guideline does is essentially teach doctors how to meet and greet service members returning from a hazardous workplace with valid physical concerns and address those concerns in an expeditious way -- the sort of way that they're entitled to after having served their country and made important sacrifices," Engel said.

He said this helps patients trust their healthcare providers, which helps clinicians provide better care.

"A big part of the guideline is informing providers as to what sorts of tests that they should run, but I'd say an even bigger part of the guideline is helping clinicians to recognize that there are strategies they can use to embrace the returning veterans' health concerns," Engel said.

The guidelines don't contain a strict definition of "deployment." Engel explained there are countless situations in which military service members might experience hazardous exposures -- be they psychological, industrial or environmental.

"This is an evaluation for people who've been to what essentially amounts to a hazardous workplace -- a deployment of some sort -- in service to their country," he said. Engel said the team developing the guidelines didn't want to use a strict definition of deployment, because that might exclude people from being treated properly under the guidelines.

"It becomes a way that many veterans feel like they're being cut out of care rather than brought into it," Engel said. "If the person relates their health concern to a deployment, however improbable the healthcare provider might think that is, they are cared for under this guideline."

For more information on post-deployment healthcare, visit http://www.pdhealth.mil/.

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