Lessons Learned: Setting some rules for part twos

 Lessons Learned: Setting some rules for part twos

Recommendations without follow through are inefficient at best, intentional grounding at worst. Neither of these labels advance.

Our health is our wealth; it factors into every avenue of our life. There is no room for intentional grounding of the health of the deployed, let alone inefficient operations.

Recommendations are the lessons learned in healthcare. Many healthcare organizations, operations and issues are accompanied by improvement agenda. Much of the industry is held to recommendations in reports through reimbursement, consumer marketing, annual updates to the company, board oversight and/or general good management. Comparatively, much of the military is held to politics, administration and security. The latter environment would warrant a more structured approach to public reporting on recommendation follow through, yet there is none. In fact, the primary way the military even gets its recommendations is through specific request; lessons learned through health report recommendations are not a consistent operation.

With respect for the sensitive topic of soldier health as a country's guarded interest, an overarching lesson learned is that of the need to advance deployment health away from rotating administrations and into greater healthcare. 

Again, an individual's occupational health, particularly one that affects the greater public's health, should not be under exclusive oversight of any termed administration. To drive home an example, approximately 10% of active duty service members deployed to Iraq and Afghanistan between 2003 and 2014 received a new TBI diagnosis within 3 years after returning from these deployments. There is nowhere in the world where healthcare would tolerate incidence and prevalence rates like this. Not one global health or local public health agency would accept the status quo of politically appointed workplace oversight. Yet this statistic evades greater healthcare responsibility. Epidemiological recommendations for interventions afforded to every other population, and every other setting, must also be applied to this population.

To advance the recommendations component of deployment health, expertise should be called at the national level. These groups should organize and formalize lessons learned and next steps. Follow up, the part two, should be required pressure at the global level.

In the United States, a leading country of the deployed, experts can examine several working documents. Follow through lost and completed follow through now incorporated in military and veteran health operations can be identified. Components not yet completed, not relevant or that need to incorporate newly identified concerns can be organized for a seat at the global table. 

⦾ Overall protections for the deployed start with medical surveillance, records and general health organization recommendations. 

Strategies to Protect the Health of Deployed U.S. Forces: Medical Surveillance, Record Keeping, and Risk Reduction (1999) 

* recommendations include development of a system for medically unexplained symptoms, recruitment assessment, responsibilities to preventive medicine, post-deployment science, privacy in records, information technology for health, records maintenance, risk communication and inclusion of reserve forces into surveillance, records and risk reduction.

Strategies to Protect the Health of Deployed U.S. Forces: Force Protection and Decontamination (1999)

* recommendations include improvements to equipment, PPE,  training protocols in chemical and biological warfare risk-based decisions, decontamination, liquid and vapor insight, collection protection consideration. 

In the 20 years since these recommendations, what has been implemented? What has been aligned internationally?  In the 20 years since the Institute of Medicine/National Academies of Medicine placed two reports on the subject, what has been advanced? 

⦾ Recommendations for veteran deployed healthcare have been compiled and advanced. There are many documents, below are a few listed. Where is overall public health structure? 

Gulf War and Health Volume 10: Update of Health Effects of Serving in the Gulf War, 2016 (2016)

* recommendations include improvements in specific research, cancer epidemiology, therapeutics, collaborative work in healthcare services for the population

Gulf War Illness and the Health of Gulf War Veterans: Research Update and Recommendations, 2009-2013, Research Advisory Committee on Gulf War Veterans’ Illnesses 

*recommendations include improve methodology of research, depth of data, focus on long term health, therapeutics

How is Deployment to Iraq and Afghanistan Affecting U.S. Service Members and Their Families (2011)?

* recommendations include improvements to research, policies, utilization and access to care, mental health priorities, stable predictions and consistency to deployment, manage perception and expectations, family support

There are volumes of literature that can be consumed on overall deployment health. What has been introduced from this work, and what is being done internationally? 

⦾ Ongoing analyses

Recommendations for improved knowledge and interventions around on limb salvage, burn treatment, neurological effects of blasts, mental healthcare, genetics and reproduction, and disability are just a select few reports commissioned. Where is the overarching healthcare gameplan that incorporates these recommendations?  

⦾ Recommendations for facilities, departments and administrations should be examined for specific healthcare advances that apply to the population itself. 

Utilization, access, cost, health quality of life and consumer satisfaction should be examined from a population perspective, not just for the users of the VA. See example.

Health needs, access and consumer satisfaction should incorporate all veteran and active duty populations. See example.

In examining a country's lessons learned by structuring recommendation follow through, a global network can begin to highlight critical next steps. There are several benefits to globally organizing lessons learned and recommendations not applied, including assured representation. In example, while conflict zones may not be appropriate, rights advocates can speak to health and child solider updates. In another example, peer presence can support opposing antagonistic forces at the apolitical healthcare table.

Our health is our wealth; it factors into every avenue of our life. There is no room for intentional grounding of the health of the deployed, let alone inefficiency. Military and veteran deployed reports on health should be accompanied by formal reviews and expert panel part twos, as a rule. 

There is tremendous expertise, passion and commitment from scientists, military health and other clinicians. This is likely true in many countries. Advancing lessons learned can be done by setting rules, at a global table, for follow up and follow through.