A review of 10 years of systematic health surveillance in the Army

Exercise ASKARI SERPENT: enabling clinical data collection during exercises and operations to support future contingency planning and assurance of category-based reporting systems

INTRODUCTION

Exercise ASKARI SERPENT (Ex AS) is a British Army exercise that provides primary healthcare (PHC) to Kenyan civilians in support of local health authorities. It is conducted in partnership with the Kenya Defence Force Medical Services (KDFMS). Accurate epidemiological data is critical in planning the exercise and for any future short-notice contingency operations in similar environments. This paper reports epidemiological data for Ex AS using a novel data collection system.

METHODS

PHC on Ex AS was delivered by trained and validated combat medical technicians (CMTs) using a set of Read-coded protocols. The CMTs were also directly supported and supervised by medical officers and nurses.

RESULTS

A total of 3093 consultations were conducted over a 16-day period. Of these, 2707 (87.5%) consultations fell within the remit of the CMT protocols, with only 386 consultations (12.5%) being conducted exclusively by the medical officers or nurses.

DISCUSSION

A Read-coded matrix built on CMT protocols is a simple and useful tool, particularly in civilian populations, for collecting morbidity data with the vast majority of conditions accounted for in the protocols. It is anticipated that such a system can better inform training, manning, medical material and pharmaceutical procurement than current category-based morbidity surveillance systems such as EPINATO (NATO epidemiological data). There is clear advantage to directly linking data capture to treatment algorithms. Accuracy, both in terms of numbers and condition, is likely improved. Data is also captured contemporaneously rather than after indeterminate time. Read coding has the added benefit of being an established electronic standard. In addition, the system would support traditional reporting methods such as EPINATO by providing increased assurance.

What are the effects of having an illness or injury whilst deployed on post deployment mental health? A population based record linkage study of UK army personnel who have served in Iraq or Afghanistan

BACKGROUND

The negative impact of sustaining an injury on a military deployment on subsequent mental health is well-documented, however, the relationship between having an illness on a military operation and subsequent mental health is unknown.

METHODS

Population based study, linking routinely collected data of attendances at emergency departments in military hospitals in Iraq and Afghanistan [Operational Emergency Department Attendance Register (OpEDAR)], with data on 3896 UK Army personnel who participated in a military health study between 2007 and 2009 and deployed to Iraq or Afghanistan between 2003 to 2009.

RESULTS

In total, 13.8% (531/3896) of participants had an event recorded on OpEDAR during deployment; 2.3% (89/3884) were medically evacuated. As expected, those medically evacuated for an injury were at increased risk of post deployment probable PTSD (odds ratio 4.27, 95% confidence interval 1.80-10.12). Less expected was that being medically evacuated for an illness was also associated with a similarly increased risk of probable PTSD (4.39, 1.60-12.07) and common mental disorders (2.79, 1.41-5.51). There was no association between having an OpEDAR event and alcohol misuse. Having an injury caused by hostile action was associated with increased risk of probable PTSD compared to those with a non-hostile injury (3.88, 1.15 to 13.06).

CONCLUSIONS

Personnel sustaining illnesses on deployment are just as, if not more, at risk of having subsequent mental health problems as personnel who have sustained an injury. Monitoring of mental health problems should consider those with illnesses as well as physical injuries.

The Deployment Health Surveillance Program: vision and challenges of health surveillance for Australian military cohorts

The Australian Government has supported the establishment of a Deployment Health Surveillance Program for the Australian Defence Force. Although some health screening mechanisms already exist for Australian Defence Force personnel, until now health data have been used largely for clinical management at an individual level and have not been aggregated to identify trends in health and risk factors in the shorter or longer term. We identify challenges for and potential benefits of health surveillance in the military context, describe features of the Program and progress to date. Retrospective and cross-sectional projects based on deployments to the Near North Area of Influence since 1997 are under way. A planned prospective model of health surveillance for those deploying to the Middle East promises more timely attention to any emerging health problems for military personnel and veterans.