Perspectives: commander's introduction.
Author: Volpe, Philip
Pub Date: 07/01/2012
Publication: Name: U.S. Army Medical Department Journal Publisher: U.S. Army Medical Department Center & School Audience: Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2012 U.S. Army Medical Department Center & School ISSN: 1524-0436
Issue: Date: July-Sept, 2012
Accession Number: 301479547
Full Text: Among the many important responsibilities I have assumed as Commanding General of the US Army Medical Department Center and School (AMEDDC&S) is publication of military medicine's very own professional periodical, the AMEDD Journal. I am pleased to present the first issue of the Journal to be published during my tour. The AMEDD Journal is the only periodical published by military medicine for medical professionals to present and discuss topics which stimulate, enhance, and advance the science of military medicine, the primary mission of which is to ensure the health and combat effectiveness of our nation's military force. The scope and application of such professional writing is, of course, not limited to the practice of medicine in the military environment. The majority of the information found in the pages of the AMEDD Journal is relevant, and often directly applicable, to the civilian world of medical science and healthcare delivery. Throughout the history of military medicine are found examples of discoveries, advancements, and developments that found immediate application in civilian healthcare, thereby benefitting human society as a whole.

In 1994, The Surgeon General directed the AMEDDC&S to establish an Army Medical Department periodical to be a forum for military medical professionals to present and discuss current healthcare topics and issues, as well as combat theater experiences, for the advancement of military medical science and doctrine development. Since that first issue in October of 1994, the AMEDD Journal has evolved in scope, sophistication, and presentation of its content. The Journal joined the ranks of the world's most respected medical periodicals in 2009 when it was chosen by the National Library of Medicine for inclusion and indexing in MEDLINE, the nation's premier bibliographic database of life sciences and biomedical information. Indicative of that recognition is the broad readership reflected in its distribution. Not only is it welcomed by Army, Navy, Air Force, and Defense Department recipients, the Journal is also found in many civilian medical schools, libraries, and research institutions, as well as foreign military medical organizations and commands. The AMEDD Journal is a superb presentation of who we are and what we do as healthcare professionals, both on the battlefield and in garrison.

The AMEDD Journal is an invaluable clearinghouse for the most important healthcare information and combat experiences related to maintaining a healthy, viable, effective fighting force. The Journal receives manuscripts from across the entire spectrum of medical professionals, including highly experienced medical and dental practitioners, accomplished research scientists, preventive medicine and public health specialists, veterinarians, healthcare support and service specialists, and nonmedical professionals who contribute to healthcare delivery in various ways. The diversity of subject matter is clearly indicative of the depth and breadth of responsibilities and functions found in today's military medicine.

This issue was sponsored by COL Mustapha Debboun, the senior medical and veterinary entomologist at the AMEDDC&S and Chairman of the AMEDD Journal Editorial Review Board. For the seventh consecutive year he has organized and assembled an outstanding collection of articles featuring topics related to public health, preventive medicine, and force health protection. Time and again throughout military history, the success or failure of battles, campaigns, and even wars has been determined by the health, and therefore the effectiveness, of a fighting force. There are many examples which demonstrate that it does not matter if a military force has the best training, the finest equipment, and the most capable leadership if the Warriors themselves cannot physically perform their tasks. Indeed, our primary mission at the Army Medical Department begins and ends with the health of the individual Soldier, from his or her first day at basic training until the last day in the Army. Force health protection is the keystone to ensuring that a commander has enough healthy, effective Warriors where and when needed to initiate, sustain, and complete all operations dictated by the unit's mission.


One disease threat that has plagued humankind throughout history is rabies, and it remains present in one form or another in almost every area in the world. Even though the well-understood threat of rabies is the subject of repeated training throughout military units, and regulations are established to minimize the potential for contact with infected animals, it still occurs. Indeed, in 2011 a US Army Soldier died from rabies he acquired from a dog bite in Afghanistan. This occurrence, albeit rare, serves to underscore the inescapable facts that rabies exists, and it still kills humans who become infected if prompt notification and treatment do not follow. This threat is even more serious to our military personnel who find themselves in areas where rabies may be endemic, not an uncommon situation. Edwin Cooper and COL Debboun open this issue of the AMEDD Journal with an important article that reinforces the importance of understanding that the threat of rabies to military personnel exists, it is serious, and what is necessary to minimize the potential of contracting this pernicious disease. This article should serve as a refresher in what to do and, perhaps more importantly, what not to do in combating the horror that is rabies.

The value of the military working dog (MWD) in many environments, including garrison security, disaster recovery, and combat operations, is now an indisputable fact. Each of those dogs represents a significant monetary investment in procurement, training, and support. Further, as clearly demonstrated throughout the last issue of the AMEDD Journal, specially trained dogs are increasingly found in medical treatment roles within the military, whether for physical assistance, in psychological and physical therapy settings, or as companions for emotional support. Understandably, the health of these dogs is important, not only because of the monetary investment, but also because dogs can carry diseases transmittable to humans. In their article, CPT Lee McPhatter and his coauthors report on their investigation of the insect vector of one such disease on military installations in and around San Antonio, Texas. As pointed out in their article, not only is Chagas disease a significant health threat to MWDs, but it also sickens over 7 million people worldwide, and kills approximately 21,000 each year. Their important article is a detailed presentation of a well-designed, carefully executed, thorough search for triatomine bugs, not only in areas where they represent a threat to dogs being raised and trained for service in government agencies, but also in military training areas where the potential to infect humans is very real.

Leptospirosis is another zoonotic disease that presents a significant threat to humans worldwide, especially in areas where military deployments may be expected, such as combat environments and scenes of natural disasters. Therefore, it is very important that medical caregivers have the capability to detect the Leptospira bacteria in austere environments, where infrastructure and transportation resources may be limited at best. James McAvin and his coauthors present their work in the development of a field-expedient method to identify the presence of Leptospira in rats, the most significant reservoir of the disease causing agents. Their article is an excellent example of a carefully designed and meticulously executed research project, presenting the methodology and science of their research with clarity and detail. The results of their efforts should provide caregivers with the capability to detect another serious disease threat in remote, austere locations, allowing them to quickly narrow the field of diagnostic possibilities in the treatment of sick personnel.

The capabilities of our fighting forces become increasingly sophisticated and effective as their training, equipment, and support infrastructure continue to evolve in response to the ever-changing nature of the enemy threat. Detection, identification, and analysis of that threat is essential to formulating the appropriate response. The same principle applies to the threats they face from vector-borne diseases which can vary significantly across geographic locations and climates. In their detailed article, MAJ Michelle Colacicco-Mayhugh and her coauthors describe the current structure and functioning of the US military's entomological support in the Afghanistan theater of operations. This article provides excellent insight to the complex coordination and planning that is necessary to ensure that entomological resources are available when and where needed in the challenging, widely dispersed, fluid, and dynamic combat environment of Afghanistan.

Organophosphates and closely related chemicals are toxic substances routinely introduced into our environment because they are found in a number of commercially available insecticides. However, the same substances are components of potent neurotoxic chemical warfare agents, such as sarin. The potential risk posed by either application has, of course, stimulated a number of approaches to decontamination, from simple bleach to specifically developed decontamination compounds. But most techniques to determine the effectiveness of decontamination efforts involve expensive equipment and trained technicians. Retired CDR David Clayborn and his colleagues from Missouri State University investigated the effectiveness of a relatively simple and inexpensive bioassay technique using measured survival of red flour beetles to judge the level of toxic residue. The article is the report of their detailed, rigorous research project which evaluated the effectiveness of that approach. The results of the study are encouraging, demonstrating that the approach offers the potential of a rapid, very low expense bioassay that accurately measures biological toxicity of surfaces previously contaminated with malathion and malaoxin. This technique may be developed into an initial screening tool for field environment applications to determine the decontamination of a variety of toxic environments.

In a 2010 AMEDD Journal article, Dr Coleen Baird discussed the emerging recognition of the potential hazard to the respiratory health of deployed personnel (and others) posed by open burn pits around bases in Iraq and Afghanistan. In 2011, she followed with another article investigating the questions of increased incidences of respiratory difficulties among troops returning from combat deployments. The increasing interest and concern about these topics led to a Department of Veterans Affairs request that the Institute of Medicine form a committee to determine the long-term health effects from exposure to burn pits. In her latest article, Dr Baird examines the resulting report, describing the approach used by the study committee, and their findings. She also discusses the responses to the report by the military and the VA in their continuing efforts to definitively understand, and potentially quantify, any relationships between burn pit exposure and the health of deployed personnel. Dr Baird's excellent series of articles continue to highlight a subtle, enigmatic, but potentially serious threat to the health of our Warriors, both while deployed and after return.

In a complementary article, Jessica Sharkey examines the broad topic of all types of potential inhalational exposures to US military forces throughout the 10 years of Southwest Asia operations using records of in-theater medical treatments, medical evacuations, and postevacuation care. Her well-researched article develops the scope and character of inhalational threats, explains the difficulties involved in categorizing and quantifying exposures, and presents the available data related to such exposures throughout the decade of deployments. Ms Sharkey's article provides more insight into the difficulty that medical science faces in its efforts to address health issues resulting from the broad range of potentially harmful inhalational contaminants.

Posttraumatic stress disorder (PTSD) has been recognized, under various descriptive names, as a diagnosis mode by medical professionals for more than a century. Mental and behavioral health specialists have long been involved with research and studies as to its causes, diagnosis, and treatment, seeking to understand how and why it affects individuals to such varying degrees. In their article, LTC Sandra Escolas and her coauthors describe their work exploring how an aspect of an individual's ability to relate to others, known as attachment theory, may be a factor in how that individual deals with the stresses that induce PTSD, and influence his or her ability to cope with and recover from its symptoms. This is a carefully designed, extensively researched, meticulously conducted scientific study that produced statistically sound results. The insights contained in this important article should be of value to researchers and practitioners involved in the care and treatment of those diagnosed with PTSD.

Military personnel must maintain a high level of physical fitness throughout their military careers, and running is an integral component of the fitness regimen. Unfortunately, running all too often results in a number of injuries to the feet and legs, some of which are serious and debilitating. Over the last several years, various alternative running styles have been developed and promoted among running enthusiasts, most intended to change the footstrike to one believed less prone to cause injury. LTC Donald Goss and Dr Michael Gross conducted an extensive search and review of published information and data on the various styles to identify any biomechanical advantages, injury relationships, and trends associated with a specific style. Their article is a careful compilation of data from numerous, diverse sources, and a detailed presentation of their analysis which should be of great interest to all practitioners involved with lower body injury prevention and rehabilitation.

LTC Scott Shaffer and his colleagues return the Army-Baylor University Doctoral Program in Physical Therapy to the pages of the AMEDD Journal with a report on their study investigating the presence of neuropathy in the wrists and hands of Army dental assistants at the beginning of their training. Since dental personnel are reported to have a relatively high prevalence of upper-extremity musculoskeletal disorders, this study sought to identify preexisting conditions which might be exacerbated by the movements and positions required for their work. Indeed, they found that fully 11% of the sample population had indications of abnormalities that could be predictive of future disorders as they pursue their occupations in dental treatment. This well-designed and executed research project is another example of level of professional expertise that military medicine directs towards providing only the best "care for the caregivers" across all of our specialties.

Radiation is a word that reflexively strikes fear in most people, primarily due to the overall lack of knowledge about it, combined with the exaggerated and/or false presentations of radiation exposure in popular media. The problem of preventing inaccurate information and distorted claims from causing undue anxiety and even panic is exacerbated by today's instant, pervasive, and completely unregulated worldwide communications. COL Mark Melanson and his coauthors use 3 actual events of potential radiation exposure within the US Army to develop their article on the very important topic of communication of radiation risks. In this interesting and very informative article, they clearly explain the complexities inherent in the subject of radiation risk, the common misconceptions that must be addressed and countered, and the compounding difficulties presented by addressing it within the military context. The principles of risk communication discussed in this article are important and widely applicable for all medical professionals in this dangerous era of weapons of mass destruction.

In July 2011, the Armed Forces Health Surveillance Center, the Center for Disaster and Humanitarian Assistance Medicine, and the US Central Command sponsored a major regional conference in Abu Dhabi to promote collaboration and interoperability in responding to complex health and humanitarian emergencies. In their thorough and very informative article, Priya Baliga and her coauthors describe the diversity of attendees, the genuine interest and enthusiasm demonstrated by the participants, and the diversity of the valuable information shared throughout the conference. The reader can only be encouraged at the apparent tone of cooperation and mutual respect demonstrated throughout, as health professionals meet and interact as colleagues rather than competitors in the common goal of healthier populations throughout the region.
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