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Health & Illness In Deployed Soldiers
1. Health & Illness
Deployed Soldiers
HSC210:41497 - CULTURAL ASPECTS OF HEALTH
CECELIA WILKEN
06/02/2016
MS. PEARL
2. Learning Objectives
◦ Understand general lifestyle, day-to-day activities, stressors, and health practices of a deployed solider. How has
it changed over the years? How does it change in regard to deployment location?
◦ What health care resources are available to deployed soldiers? Do they take into account personal situations,
heritages, religions? If so, what are they?
◦ Determine what the top health concerns are for deployed soldiers. How are they acknowledged, prepared for,
prevented and treated in a deployed/battlefield setting? How are they treated post-deployment?
◦ How is health treated and viewed among soldiers, their leadership, and the health care providers taking care of
them? How does that change in a combat setting?
◦ What steps are being made to improve health and illness in deployed soldiers? Both during and post-
deployment?
3. Overview
• History & Background – Changes in Culture, Social and Medical Advancements
• Health & Illness Defined - Modern Military Deployment setting
• Healthcare Practices & Resources – Deployment
• Primary Healthcare Concerns & Circumstances
• Common Behaviors & Beliefs
• Socio-cultural Factors
• Interviewees
• SFC John Doe vs. SPC Bogeum Kim
• Culturally Competent Healthcare
• References
4. History & Background
American Civil War – Advancements through chaos
• 1861-1865
• Surgeon General William Hammond -
"the end of the medical Middle Ages.” ¹
• 1:2 Ratio – battle wounds: disease
• 760,000 deaths total ¹
• 560,000 from disease
• 200,000 from battlefield wounds
• Keystone Improvements
• Bromine – Gangrene¹
• Chloroform – Anesthetic³
• U.S. Sanitary Commission
• Army of the Potomac
• United States Nursing Corp
2
5. History & Background
WWI – Trench Warfare
• 1916-1920
• Common Ailments
• Head Injury – Wide-spread use of protective
helmet
• Musculoskeletal injuries
• Trench foot
• Infection and Disease
• PTSD or “Shell Shock”
• Keystone Improvements ¹
• Evacuation Procedures – Hospital w/in 24 hours
• Giving and Storing blood
• Musculoskeletal Treatment
• Containing Infection
• Treating shock
• Antiseptic wound treatment
• Understanding and treating PTSD
6. History & Background
WWII – Introduction of Modern Warfare
• 1939-1945
• Unique Problems
• Increased need of medications on large scale
• Multiple Combat Zones: each with different medical needs
• Pacific, Europe, Africa
• Keystone Improvements¹
• Penicillin : Mass production
• Atabrine: Protect against Malaria
• Plasma: Collect, process and transport
• Morphine as pain killer : morphine syrette
• The “Combat Medic”: attached medical
personnel – responsible for treatment of
wounded in the field and in the combat zone ²
7. History & Background
Vietnam War – DUSTOFF & jungle warfare
• Jungle & Guerilla Warfare
• MUST vs. MASH ¹
• Medical Unit Self-Contained Transportable
• Mobile Army Surgical Hospital
• Co-dependent
• Improvements ¹
• Burn patient care
• Increased vascular improvements
• Aeromedical Evacuation
• Anesthetic and critical care
8. History & Background
Women’s Role in the Combat Setting: Fighting for Equality
• Revolutionary War/ Civil War: Primarily served as nurses and cooks.
Some posed as males and fought on front lines
• WWI: 35,000 American women served as nurses, support, spies¹
• WWII: ‘To Free a Man to Fight’ ¹
• Creation of WAC, WASPs & Army Nurse Corps
• Women's Armed Service Integration Act = Permanent integration of
women in military¹
•1977: First combined gender class for BCT & MOS training¹
•2011: 14.6% of all Active duty service members are female²
•2013: Ends direct ground combat exclusion rule¹
•2014: Opens more than 33,000 closed positions¹
•2015: Army Directive 2016-01 opens positions within US Special
Operations Command & 1st 2 females become Rangers¹
•2016: All military occupations and positions become available to
women¹
9. History & Background
Race: Overcoming Prejudice & Racism
• July 1778 - 1st Rhode Island Regiment, the first all-black military unit in America¹
• October 1951 - 24th Infantry Regiment disbanded – eliminating segregation in Army¹
• 2014 - 31.2% or 412,070 of Active Duty members identify themselves as a minority²
• Black or African American, Asian, American Indian or Alaska Native, Native Hawaiian or Other Pacific
Islander, Multi-racial, or Other/Unknown
• 6.8 minority enlisted personnel to every one minority officer (Active Duty) ²
• Minority enlisted personnel - 359,056: 4.7% increase since 1995
• Minority officers - 53,014: 12% increase since 1995
• 12% of All Active Duty Personnel identifies as Hispanic²
• Army Equal Opportunity Program: “fair treatment for military personnel and Family members
without regard to race, color, gender, religion, national origin, and provide an environment free
of unlawful discrimination and offensive behavior.” AR600-02 Ch.6-2a.³
10. Health & Background
LGB(T): Moving Past “Don’t Ask, Don’t Tell”
•1994: “Don’t Ask/Don’t Tell” (DADT)¹
•As of 2010 48,500 lesbians, gay men, and bisexuals are serving on
active duty/ready reserve (2.2%) ¹
• 13,000- Active Duty – 0.9%
• 58,000 - guard and reserve forces – 3.4%
• 43% of all LGB serving are women
•Cost the military between $290 million¹
• $22,000 - $43,000/person to replace those discharged under DADT
•December 22, 2010 – President Barack Obama signs repeal of
DADT²
•Pentagon currently debating policy change for Transgender
individuals
• Current policy rules transgender as “’psychosexual condition’ that
warrants medical separation” ³
11. Defining Health and Illness Today
Deployed soldiers & their caregivers
• All Race, Gender, Age, Culture, Religion, Sexual Preference
•Primary Objectives & Goals : “To Conserve Fighting Strength”
• Role of the “Primary Caregiver”
• “…recognizes the patient as a partner, optimizes patient rights
within the health care system, and capitalizes on the value of
consumer feedback to effectively improve the processes of care”
AR 40-68 Chp3-6a.¹
• Role of the “Combat Medic” / “Medic”
• First line of medical treatment
• Must be conscientious of cultural, personal differences
• Must be prepared to step-up to leadership
• Role of the “Combat lifesaver”
• Every soldier – basic medical training
• Basic medical care – provide assistance to Medic
• Provide “Self-Aid” if necessary/able
12. Healthcare Practices & Resources
Common Deployment Healthcare System Set-up
•Mental Health: Behavioral Health Services/Chaplain
•Pre & Post Deployment Care
•Common healthcare obstacles facing deployed soldiers
• Location, Resources, Environment, Leadership
•Battlefield/ Frontline care
• 1 medic/platoon
• 1 senior medic/company
• 1 PA/Battalion
• Tactical Combat Casualty Care (TCCC)
• Care Under Fire
• Tactical Field Care
• Tactical Evacuation Care
• Collection Point: CASEVAC / MEDEVAC
• Medical Treatment Facility (MTF)
•Resources Include:
• SHARP, ACE, EO Program, Comprehensive Soldier Fitness Program, FRG
13. Health Concerns & Circumstances
Greatest Health Concerns Amongst the Deployed
•Mental Health
• PTSD, Depression, Suicidal tendencies,
Anxiety, Insomnia
•Environmental Factors
• Hot and Cold Weather Injuries
•Physical Ailments
• Broken bones, physical trauma,
musculoskeletal injury
•Disease and Illness
• STDs, Common colds/flus, Locational disease
(example: Ebola)
•Nutritional Deficiencies
14. Behaviors and Beliefs
Common cultural tendencies
• Health & Illness viewed in negative light
• Abandonment of the “sick role”
• “Suck-it-up” attitude
• Strong male atmosphere and presence
• Females = “Weak, incapable, too emotional”
• Sexism, Sexual Assault (Both genders)
• Divided up into respective races and religions,
gang mentality
• Social smoking and drinking
• Hierarchical system
• Increased suicidal tendencies
15. Socio-cultural Factors
Challenges of mixed cultures
•Gender
•Race
•Religion
•Language
• Barriers in communication
• Sexual Orientation
• Prejudice
•“Risky behaviors”
• Tobacco use
•“Rites of passage”
• Hazing has been banned
• Sexual Assault/Harassment
• Service wide crack-down
16. SGT Mallory Churning (Veteran)
Interviewee #1 – Health & Illness in a Garrison Setting (Refer to notes section for entire interview)
68W Healthcare Specialist : April of 2006 - November 2014
•Most common injury: Musculoskeletal injuries sustained during training
• How was injury viewed and treated: “most basic conservative treatments”
• “…are taught to ‘suck it up’ they push through the overwhelming warning signs that their bodies are giving them”
• “…seem to be rewarded for violating a medical professionals recommendations”
• “…congratulated by their superiors and peers for continuing the mission.”
• “I feel it is always in a negative light. Regardless of injury or condition or even the onset, it is typically viewed from my experience as being the Soldier’s
fault. A poor leadership climate, will most likely chastise the Soldier and make the situation worse. A mediocre leadership climate will check the
required boxes and play by the rules. A great command climate will meet with the Soldier to see what they can do to help the Solider meet their goals
in their healing process, without causing a scene.”
• How is deployment viewed: “…a Soldier is looked at strangely after hitting certain ranks and having never deployed. (Were they a deployment
dodger?)”
•How is religions and culture viewed: “…we typically call in the chaplain, and have the chaplain use their resources. As long an accommodation is
reasonable or legally required, it will be met.”
• What changes need to happen?:
• “Unfortunately I do not see a positive change happening for Soldiers until it happens in American culture… If an accommodation needs to be made for
you, how dare you ruffle the status quo and not be a cookie cutter Soldier. And it certainly will not change if leaders do not emulate the actions they
wish to see in their Soldiers.”
17. SPC John W. Lang (Veteran)
Interviewee #3- Health & Illness in Deployment Setting (Refer to notes section for entire interview)
68W- Combat Medic/Line Medic: April 2014-May 2016
• Most Common Injury in deployed setting: Environmental – Heat or cold weather casualties
• Biggest factor affecting quality of healthcare: “…your location relative to the next level of medical care”
• How is illness and Injury viewed?: “…extremely varied depending on the leadership present. I've had NCOs and
Officers that are very supportive of injured soldiers and understood early treatment of injuries leads to faster
recovery times, I've also had leadership who insisted on keeping individuals out in the field even after the medic
suggesting they leave and telling them to suck it up.”
• “Risky Behaviors”?: “In the field typically soldiers take up a lot of tobacco usage to kill time.”
•Culture, Gender, Religion:
• “My battalion had about 3 females in it so I've never run into any situations where females were unable to receive health care.”
• “I've personally never heard anyone complain that their cultural or religious needs were not being met with army health care.“
• Improvements?: “Better acclimation to environments you'll be deployed to or training in could help prevent a
ton of environmental or physical injuries.” & Communication with leadership
18. SFC John Doe
Active duty US Army: Infantryman, Caucasian Male, age 25, Atheist
PERSONAL INFORMATION
• 3 Deployments
• 1st: Iraq: Early war – IED, lost fellow soldiers
• 2nd: Haiti – Lost fellow soldiers, one best friend
• 3rd: Afghanistan – Senior Leader of B Company
• Joined at 18 years old right out of High School
• From San Diego, California
• Not religious: Atheist
• Suffers from/ has a history of depression, anxiety
and PTSD sustained during 1st and 2nd
deployment
• Heterosexual: Divorced with 2 children
• English: primary and only language
THINGS TO CONSIDER/ CULTURALLY COMPETENT
• Sense of duty to his soldiers: huge stress to bring
back everyone
• Mission orientated: Infantry soldier entire adult
life, divorced
• PTSD: More prone to violent outbursts, suicidal
tendencies, detrimental habits, sleeping issues
• Downplay illness and injury
• Not religious: Need to look for alternative forms
of support
• May or may not have strong feelings regarding
working with females, different races, or foreign
nationals
•Trust needs to be established: “Respect the rank,
not the individual.”
19. SPC Boguem Kim
Active Army, 13B Cannon Crewmember, Korean Female Age 20, Roman Catholic
PERSONAL INFORMATION
• Immigrant: Retaining citizenship through military
service
• No Prior deployments : 1st one, Afghanistan
• Been within military for less than 6 months
• Primary language is Korean; speaks English well,
but has difficulties understanding cultural
differences
• Heterosexual, single, never married, no children
• Highly religious
• Very conscientious of gender and comes off as
meek and introverted
• Very good at her job, very serious individual
THINGS TO CONSIDER / CULTURALLY COMPETENT
• Background and cultural differences
• Language and culture barriers
• Are you being completely understood?
• Polite instead of pursuing complete care
•Fear of persecution from command/peers
• Increased risk for mental illness issues to arise
• Depression, homesickness, seclusion from peers,
low morale, scared
• Religion: are her religious needs being met
• Risk of sexual harassment and assault
20. Culturally Competent Healthcare
3 important areas of improvement
• Location, Resources and Circumstance
• On the line vs. Within Forward Operating Base (FOB)
• Materials and Resources available
• Environmental factors
• Integration of Females into Combat Specific MOS
• Push-back
• Sexual Assault/Harassment
• Mental health
• Education & Urgency of Importance of health in Leadership
• Holding Leadership Accountable for Preventable Injuries in Soldiers
• Medical training for Leadership: Understand impact of Health and Illness
• Importance of Preventative Medicine and Measures: Physical and Mental
21. References
In order of appearance
Floyd, B. (2015, June 26). University of Toledo Libraries. Retrieved from Medicine in the Civil War: Document 8: http://www.utoledo.edu/library/canaday/exhibits/quackery/quack8.html
Reimer, T. D. (n.d.). National Museum of Civil War Medicine Artifacts Library. Retrieved from National Museum of Civil War Medicine: http://civilwarmed.pastperfect-online.com/38764cgi/mweb.exe?request=random
Goellnix, J. (n.d.). Civil War Medicine: An Overview of Medicine. Retrieved from eHistory: Department of History, Ohio State University: https://ehistory.osu.edu/exhibitions/cwsurgeon/cwsurgeon/introduction
Ahsan, D. S. (2016). How did WWI change the way we treat war injuries today? Retrieved from BBC: iWonder: http://www.bbc.co.uk/guides/zs3wpv4#z3n4mp3
Steinert, D. (2002, April 5). The History of WWII Medicine. Retrieved from WWII Combat Medic: http://www.mtaofnj.org/content/WWII%20Combat%20Medic%20-%20Dave%20Steinert/wwii.htm
Batens, A. (2002, March 19). WWII MEDICAL DETACHMENT attached to Infantry Regiment. Retrieved from WWII Combat Medic: http://www.mtaofnj.org/content/WWII%20Combat%20Medic%20-
%20Dave%20Steinert/WWIIMedicalDetachment.htm
The Mobile Army Surgical Hospital: Vietnam War – MUST vs. MASH. (2009, October 21). Retrieved from Medical Inspection: http://www.medicalinspection.net/the-mobile-army-surgical-hospital-vietnam-war-must-vs-
mash.html
Army, U. (2016). Women in the U.S. Army. Retrieved from Army.mil: https://www.army.mil/women/history/
Women In Military Service For America Memorial Foundation, Inc. (2011). Statistics on Women in the Military. Washington D.C.: Department of Defense.
United States Army. (n.d.). African American in the U.S. Army. Retrieved from Army.mil: https://www.army.mil/africanamericans/textonly.html
Office of the Deputy Assistant Secretary of Defense . (2014). 2014 Demographics: Profile of the Military Community. Retrieved from United States Department of Defense: Military One Source:
http://download.militaryonesource.mil/12038/MOS/Reports/2014-Demographics-Report.pdf
Department of the Army. (2015). Chapter 6: Equal Opportunity Program in the Army. In Army Command Policy: Army Regulation 600-02 (pp. 54-68). Washington D.C: Headquarters: Department of the Army.
Gates, G. J. (2010). Lesbian, gay, and bisexual men and women in the US military:. The Williams Institute
U.S. Naval Institute. (2016). Key Dates on U.S. Policy on Gay Men and Women in Military Service. Retrieved from U.S. Naval Institute: http://www.usni.org/news-and-features/dont-ask-dont-tell/timeline
Tilghman, A. (2016, June 13). 'I try to remain androgynous': Transgender troops in limbo as Pentagon debates policy. Retrieved from MilitaryTimes.com:
http://www.militarytimes.com/story/military/careers/2016/06/12/transgender-military-troops-pentagon-policy/85666768/
Department of the Amy. (2009). Chapter 3: Patient rights and responsibilities. In AR 40-68: Clinical Quality Management (p. 11). Washington D.C: Headquarters: Department of the Army.
From 1861-1865, the United States experienced profound casualties during the American Civil War. Neither the Confederate or Union sides were prepared for the magnitude of casualties that would be sustained, nor the medical repercussions and challenges they would experience. During those 4 years, over 760,000 individuals would die. (Floyd, 2015) For every 1 soldier who died during battle, 2 would die from disease; the most common including diarrhea, dysentery, typhoid fever and malaria. By the end of the war over 200,000 individuals would have perished on the battlefield, while over 560,000 would succumb to disease. (Floyd, 2015) Surgeon General William Hammond would refer to the American Civil War as "the end of the medical Middle Ages” due to the large steps taken to improve and understand medical care. (Floyd, 2015) Some of the many advancements developed during this time period included the formation of the first ambulance corps. The Army of the Potomac was implemented by Union General George B. McClellan in August of 1862, and was responsible for the transfer of the wounded from the battlefield into a field hospital setting. (Floyd, 2015) Because it was apparent during the beginning of the war that disease would be a leading cause of death, Frederick Law Olmstead started the U.S. Sanitary Commission in June of 1861 to work at combating diseases caused by overcrowded and unsanitary field hospital conditions. (Floyd, 2015) Many doctors, who had little to no medical experience, relied heavily on amputation over bullet extraction. At the beginning of the war there was no concept of anesthesia or antiseptic surgery, and doctor’s and nurses relied heavily upon the “surgical shock” of battle; the point at which the casualties heart rate was highest in order to preform amputations. (Floyd, 2015) With an increased knowledge of the importance of sanitary conditions, dirty, crowded, unsanitary field hospital tents turned into cleaner, well ventilated, sanitary more permanent hospitals and medical facilities, along with the need and implementation of more permanent, well-trained staff. (Floyd, 2015) In 1861 Dorothea Dix was appointed Superintendent of the United States Nursing Corp and the concept of professional nursing was born (Floyd, 2015). By the end of the war medical staff had found ways to increase the use of medicine to combat disease and improve conditions for casualties. For example, the use of bromine was used to combat gangrene (Floyd, 2015) and chloroform was used as a common antiesthetic (Goellnix).
Pictures taken from National Museum of Civil War Medicine – Artifacts Library From left to right: surgical kit, bottle of medicine, tourniquet, amputation saw, syringe
¹Floyd, B. (2015, June 26). University of Toledo Libraries. Retrieved from Medicine in the Civil War: Document 8: http://www.utoledo.edu/library/canaday/exhibits/quackery/quack8.html
²Reimer, T. D. (n.d.). National Museum of Civil War Medicine Artifacts Library. Retrieved from National Museum of Civil War Medicine: http://civilwarmed.pastperfect-online.com/38764cgi/mweb.exe?request=random
³Goellnix, J. (n.d.). Civil War Medicine: An Overview of Medicine. Retrieved from eHistory: Department of History, Ohio State University: https://ehistory.osu.edu/exhibitions/cwsurgeon/cwsurgeon/introduction
With the introduction of trench warfare in World War I many new methods were developed when treating some common as well as new ailments experienced by soldiers on the battlefield. (Ahsan, 2016) Head injuries were especially common and the protective helmet developed and implemented, trauma from explosions lead to amputations of the arms and legs, injuries sustained to the torso oftentimes resulted in death on the battlefield or en-route to a hospital, because of the squalid, wet and rancid conditions of the trenches infection and disease was common along with trench foot, which resulted from individuals standing in water for long periods of time. (Ahsan, 2016) One of the most important improvements made during WWI was the evacuation of injured soldier and speed of treatment. Injured soldiers were now able to arrive at a hospital within 24 hours, which vastly improved individuals chances of survival. (Ahsan, 2016) Giving and storing blood was also a new method used during the war, before they developed a method to store blood, casualties were oftentimes connected directly to a healthy viable individual. A U.S. Army doctor, Captain Oswald Robertson, found a way to utilize sodium citrate to prevent the blood from coagulating and becoming unusable. (Ahsan, 2016) At the beginning of the war 80% of all soldiers with a broken femur died. By 1916, 80 % of soldiers with this injury survived due to the development of the Thomas splint by Hugh Owen Thomas, which secured broken leg. (Ahsan, 2016) In addition, there were advancements in shock treatment of wounds, by using an IV treatment with saline, the utilization of blood transfusions, and antiseptic wound treatment. The Carrel-Dakin technique used sodium hypochlorite, which was poured directly to damaged tissue in deep wound-beds helping contain infections and sanitize the wound. (Ahsan, 2016) The treatment of typhus fever in poor trench conditions lead to a greater understanding and improvement of hygiene and hygienic practices used in hospitals and in field conditions. Also, approaches to treating and understanding PTSD (Post Traumatic Stress Disorder) with Cognitive Behavioral Therapy (CBT) were developed and the first steps were taken in determining how to treat mental illness. (Ahsan, 2016)
Pictures from left to right: Blood transfusion kit, Diagram of a Thomas Splint, Diagram of common Evacuation Procedure in WWI (Ahsan, 2016)
¹ Ahsan, D. S. (2016). How did WWI change the way we treat war injuries today? Retrieved from BBC: iWonder: http://www.bbc.co.uk/guides/zs3wpv4#z3n4mp3
World War II introduced a wide range of new medical needs specific to each war front they experienced. Europe, The Pacific and Africa all required different medical needs and challenges in care. With a steady increase in medical advancements prior to the start of the war the medical industry was kick-started with the implementation in war, as more medical requirements needed to be met. Infection was known to be treated with the discovery of penicillin by Sir Alexander Fleming in 1906, but it wasn’t until 1941 that John Davenport & Gordon Cragwell, of Pfizer Pharmaceuticals, developed techniques to mass produce the drug. (Steinert, 2002) The discovery of pasteurization also lead to the development of food rations able to store and kept from spoiling for a longer period of time. Quinine was previous used to treat malaria, and came from a root from many trees located in the Andes of South America but was cut off by Japanese forces. So atabrine was developed by a German researcher in lea of the quinine. (Steinert, 2002) However, the drug came with some unfavorable side-effects such as headaches, nausea, vomiting, sometimes even leading to temporary psychosis. As a result, soldiers were watched in order to ensure they actually ended up taking the drug. In 1938, Dr. Charles Drew created and implemented system that collected, processed and transported 14,500 units of plasma - all within five months. (Steinert, 2002) The collection was so successful that many units of plasma were able to be returned to the civilian sector for use after the war. (Steinert, 2002) Morphine was used as a pain killer and Squibb, a pharmaceutical company, developed the morphine syrette which allowed medics to inject morphine directly into patient (Steinert, 2002) If the drug was applied, the syrette was pinned to the casualties collar to prevent overdosing of unconscious patients (Steinert, 2002) This is a practice still used for other drugs administered today (i.e.: epinephrine shot). (Army, 2011 Ed. )
The use of Combat Medics in small team structures came with the change of warfare style and technological advancements, which required to have platoons work in small team set-ups (Batens, 2002) In combat, 2 (or more) Company Aidmen of the Company Aid Squad are usually assigned to each Rifle Company to dress wounds and provide first aid (FM 7-30 Infantry Field Manual, July 19, 1941) There were 3 separate squads ; Aid Station Squad, Litter Bearer Squad ; and Company Aid Squad (FM 7-30 Infantry Field Manual, July 19, 1941) “Rifle Regiment (Infantry) was entirely composed of INFANTRYMEN, the only exception being the attached medical personnel – responsible for treatment of wounded in the field and in the combat zone”. (Batens, 2002)
¹Steinert, D. (2002, April 5). The History of WWII Medicine. Retrieved from WWII Combat Medic: http://www.mtaofnj.org/content/WWII%20Combat%20Medic%20-%20Dave%20Steinert/wwii.htm
²Batens, A. (2002, March 19). WWII MEDICAL DETACHMENT attached to Infantry Regiment. Retrieved from WWII Combat Medic: http://www.mtaofnj.org/content/WWII%20Combat%20Medic%20-%20Dave%20Steinert/WWIIMedicalDetachment.htm
During the Vietnam War with jungle warfare came the implementation of guerilla warfare. Which presented issues when supplying soldiers with resources and treating and extracting casualties. This resulted in the formation of MUST and MASH medical facilities. MUST, Medical Unit Self-Contained Transportable, were easily moved, expandable, mobile shelters with inflatable ward sections, radiology, laboratory, pharmacy, dental and kitchen areas (The Mobile Army Surgical Hospital: Vietnam War – MUST vs. MASH, 2009) MASH, Mobile Army Surgical Hospital, were more permanent hospitals, larger, increased stock & supplies, more abilities to treat wider range of illness and wounds (The Mobile Army Surgical Hospital: Vietnam War – MUST vs. MASH, 2009) They worked hand-in-hand with one another; MUST treated the more easily treatable wounds and illness, sending injured soldiers back to their respective companies once they were treated and recovered. MASH handled the more seriously injured patients needing more permanent residence, or those who required medical stabilization before returning to a medical hospital at another location. There were many medical improvements developed during the war. (The Mobile Army Surgical Hospital: Vietnam War – MUST vs. MASH, 2009) The most improvements were within burn patient care. Military surgeons developed sulfamyalon and came to realize that fluid resuscitation was vitally important in the treatment of burns. This resulted in a 50% reduction in mortality for burn patients. (The Mobile Army Surgical Hospital: Vietnam War – MUST vs. MASH, 2009) There was an increase of vascular improvements, which meant the decrease of need to amputate. These improvements in vascular surgery during the Vietnam War resulted in an average amputation rate of 8% (The Mobile Army Surgical Hospital: Vietnam War – MUST vs. MASH, 2009) With the implementation of Aeromedical Evacuation this vastly improved mortality rate. Injured patients could be at a hospital or medical treatment facility within 2 hours versus the previous 24 hours. The Vietnam war also brought about improvements in anesthesia and critical care.
¹The Mobile Army Surgical Hospital: Vietnam War – MUST vs. MASH. (2009, October 21). Retrieved from Medical Inspection: http://www.medicalinspection.net/the-mobile-army-surgical-hospital-vietnam-war-must-vs-mash.html
Major social and cultural changes in the military over the years
Implementation of women into service/ combat settings (Army, Women in the U.S. Army, 2016)
-Primarily served as nurses and cooks from Revolutionary War until last 2 years of WWI, when 33,000 are allowed to serve as nurses and support staff
-WWI: 35,000 American women served as nurses, support, spies
-WWII: ‘To Free a Man to Fight’ – Creation of Women’s Army Corps (WAC) & Women’s Airforce Service Pilots (WASPs) & Army Nurse Corps
-Women's Armed Service Integration Act was signed into law by President Harry S. Truman, June 12, 1948 = Permanent integration of women
-1977: First combined gender class for BCT & MOS training
-2011: 214,098 served Active duty – 14.6% / 19.5% Reserve / 15.5% National Guard (Women In Military Service For America Memorial Foundation, Inc., 2011)
-2013: Ends direct ground combat exclusion rule
-2014: Opens more than 33,000 closed positions
-2015: Army Directive 2016-01 opens positions within US Special Operations Command & 1st 2 females become Rangers
-2016: All military occupations and positions become available to women
¹Army, U. (2016). Women in the U.S. Army. Retrieved from Army.mil: https://www.army.mil/women/history/
²Women In Military Service For America Memorial Foundation, Inc. (2011). Statistics on Women in the Military. Washington D.C.: Department of Defense.
¹United States Army. (n.d.). African American in the U.S. Army. Retrieved from Army.mil: https://www.army.mil/africanamericans/textonly.html
²Office of the Deputy Assistant Secretary of Defense . (2014). 2014 Demographics: Profile of the Military Community. Retrieved from United States Department of Defense: Military One Source: http://download.militaryonesource.mil/12038/MOS/Reports/2014-Demographics-Report.pdf
³Department of the Army. (2015). Chapter 6: Equal Opportunity Program in the Army. In Army Command Policy: Army Regulation 600-02 (pp. 54-68). Washington D.C: Headquarters: Department of the Army.
¹Gates, G. J. (2010). Lesbian, gay, and bisexual men and women in the US military:. The Williams Institute
²U.S. Naval Institute. (2016). Key Dates on U.S. Policy on Gay Men and Women in Military Service. Retrieved from U.S. Naval Institute: http://www.usni.org/news-and-features/dont-ask-dont-tell/timeline
³Tilghman, A. (2016, June 13). 'I try to remain androgynous': Transgender troops in limbo as Pentagon debates policy. Retrieved from MilitaryTimes.com: http://www.militarytimes.com/story/military/careers/2016/06/12/transgender-military-troops-pentagon-policy/85666768/
¹Department of the Amy. (2009). Chapter 3: Patient rights and responsibilities. In AR 40-68: Clinical Quality Management (p. 11). Washington D.C: Headquarters: Department of the Army.
What is/was your name, rank, MOS? How long have you served in the military? If you are a veteran, how long ago did you exit the service?
Mallory Showalter Churning, SGT USA – 68W Healthcare Specialist, commonly referred to as “medic” or “combat medic”
My military service began in April of 2006 and ended November 2014.
How many deployments have you gone on? To where? What did you do while there? You may also include extended training missions.
I was never deployed in my career, to my own disappointment. As a hospital medical I was assigned (PROFIS-Army professional filler system) to support the 121st CSH out of Yougsan Korea. I completed 3 TDY training missions with them in support of 2IDs annual training exercises for the entire peninsula. (Think war games)
What are the most prevalent health and illness prevalent in service members? This can be physical as well as mental. How are these issues prevented and treated? From your experience, can you tell a difference between deployed soldiers vs. non-deployed soldiers in a medical sense? Mental status, attitude, certain physical ailments?
In my career, the most overwhelming health issues I saw in Army Soldiers were musculoskeletal issues. Typically as the result of training. Generally, there were issues with Soldiers new to the Army and physical training was a complete shock to their bodies, or Soldiers that were in fantastic shape, suffered an injury, and were not able to let it heal properly due to mission or command requirements.
The issues were always treated with the most basic conservative treatments. But since Soldiers are taught to “suck it up” they push through the overwhelming warning signs that their bodies are giving them and then become candidates for major surgeries at the prime of their career, and much younger than the average patient of that procedure (i.e. hip replacements, knee surgeries, should surgeries). They (Soldiers) seem to be rewarded for violating a medical professionals recommendations. I have seen many Airborne Soldiers purposely violate a “no airborne operations” profile after a concussion (mild TBI) and then congratulated by their superiors and peers for continuing the mission.
As for telling a difference between deployed and garrison soldiers, I don’t think there is a way to tell without a positive confirmation (i.e. deployment patch, looking at ERB/ORB, or confirmed conversation). I do believe with the current war that a Soldier is looked at strangely after hitting certain ranks and having never deployed. (Were they a deployment dodger?)
In your opinion, how are individuals who are suffering from an illness, mental or physical, viewed by their peers? Is it a positive or negative reaction? How does leadership handle these issues? What steps are taken to ensure a quality working environment for these individuals?
I feel it is always in a negative light. Regardless of injury or condition or even the onset, it is typically viewed from my experience as being the Soldier’s fault. A poor leadership climate, will most likely chastise the Soldier and make the situation worse. A mediocre leadership climate will check the required boxes and play by the rules. A great command climate will meet with the Soldier to see what they can do to help the Solider meet their goals in their healing process, without causing a scene. (Can’t do a particular exercise, what can we do to help keep you in shape, while letting you heal?) BOTTOM LINE, if it’s not written on DA 3349 we aren’t doing anything special for you.
What are some obstacles that face health care professionals in a military hospital setting? This can be physical, mental, environmental, religious etc.… Are there programs, organizations, rules or regulations that help as guidelines for health care professionals to follow? If so, what are they? In your opinion do they help or are they inhibiting?
For enlisted personnel depending on your job, your training quality may be your biggest obstacle. Also, your leadership maybe a hurdle. Running a hospital which also employs civilians cannot be run like a traditional military unit. Your leaders need to have a background on how hospital administration works, because you have to process payroll, civilian evaluations, continuing education requirements, additional regulations and regulatory agencies (Joint Commission), Patient Safety Goals, etc. You cannot expect a field Soldier of 15 years to come in and have a grasp on any of these concepts.
If any, what sort of “risky behaviors” or “rites of passage” may a solider experience? Picking up dangerous habits? Hazing? Harassment? Seclusion? Sexual or physical abuse? How prevalent are these in a garrison setting? Do they increase when compared to deployed life?
I don’t think I have any experience personally in any of these possible experience. I personally joined the Army “older” and college educated. (Which probably play a factor in some of these instances.)
How does gender affect healthcare in a medical setting? Are females and males treated differently with regards to health in a setting?
In my experiences in an inpatient setting, emergency room setting, and a ground ambulance unit, women and men are treated differently. Men based on size and strength are almost always asked to help with moving patients, heavy lifting, etc. Women are typically used as “baby sitters.” (Sit and take care of this patient). Women are seen as more compassionate and often the patient with a laundry list of complaints will be sent to her. In the hospital setting, women are more likely to have to take care of pediatric patients, geriatric patients, and other women patients.
How important is it in the health care systems to make accommodations to individual’s religious, and cultural preferences? Are attempts made to understand and accommodate those individuals who come from different cultures and backgrounds?
I’ve never had an issue with needed to accommodate a religious, or cultural preference. In those situations we typically call in the chaplain, and have the chaplain use their resources. As long an accommodation is reasonable or legally required, it will be met.
In your opinion what areas and aspects of treating health and illness in soldiers need improvement? This can include changes in ways of thinking and behaviors to actual physical changes to how treatment is given or how regulations are written. How would you change or fix these situations?
Unfortunately I do not see a positive change happening for Soldiers until it happens in American culture. If you call out sick for a day, you are often viewed as slacking, If it is anything short of needing to be admitted to the hospital. Americans don’t take time off to heal, we keep pushing through, we will be alright, all of our other commitments must be met. It is not honorable to put your wellbeing first, you need to complete your mission/task. If an accommodation needs to be made for you, how dare you ruffle the status quo and not be a cookie cutter Soldier. And it certainly will not change if leaders do not emulate the actions they wish to see in their Soldiers. (If they are injured they need to follow their profile.)
Churning, M. (2016, June 6). Health & Illness: Soldiers in a Garrison Setting. (C. Wilken, Interviewer)
1. What is your name, rank, MOS? How long have you served in the military? If you are a veteran, how long ago did you exit the service?
John Lang, SPC, 68W. Joined April 2014. I've been out of the army since May 22nd,2016
2. How many deployments have you gone on? To where? What did you do while there? You may also include extended training missions.
I've never been on a combat deployment. I went to JRTC at Fort Polk twice each were a month long. I went to NTC in California for a month. I also spent two months in Kenya training with 3 paratrooper battalions.
3. How does dealing with health and illness differ in a deployment setting as opposed to garrison life?
In garrison life you have every medical resource imaginable where as in a deployment setting or long field problems you're typically on your own with your group of infantrymen and lucky to have a PA available to you.
4. How are health care systems set up in a deployment setting? What are the biggest factors that affect quality and resources of health care in a deployed setting?
From my experience in an infantry battalion. When deployed for training or combat each infantry platoon is assigned one medic. Each company is assigned one company medic with a little more experience.
One PA is assigned over the entire battalion. The biggest factor from my experience is your location relative to the next level of medical care.
5. What are the most prevalent health and illness prevalent in deployed service members? This can be physical as well as mental. How are these issues prevented and treated?
From my experience the most prevalent health issues were environmental. We typically going out into whatever environment it is we don't have enough time to acclimate or train up and experience a ton of Heat or cold weather casualties.
6. In your opinion, how are individuals who are suffering from an illness, mental or physical, viewed by their peers? Is it a positive or negative reaction? How does leadership handle these issues? How do you feel leadership should handle these issues?
The reaction to individuals suffering from an illness is extremely varied depending on the leadership present. I've had NCOs and Officers that are very supportive of injured soldiers and understood early treatment of injuries leads to faster recovery times, I've also had leadership who insisted on keeping individuals out in the field even after the medic suggesting they leave and telling them to suck it up.
7. What are some obstacles that face health care professionals in a deployment setting? This can be physical, mental, environmental, religious etc.… Are there programs, organizations, rules or regulations that help as guidelines for health care professionals to follow? If so, what are they? In your opinion do they help or are they inhibiting?
The obstacles I've personally faced as a health care provider in the field are typically access to higher levels of care whether that's because we were far from treatment or our constant communication issues.
8. If any, what sort of “risky behaviors” or “rites of passage” may a solider experience during deployment? Picking up dangerous habits? Hazing? Harassment? Seclusion? Sexual or physical abuse? How prevalent are these in a deployment setting? Do they increase/decrease when compared to garrison life?
Since I've been in the military acts of hazing had been really cracked down on so you see less of it. I never saw any kinds of hazing or harassment happening. In the field typically soldiers take up a lot of tobacco usage to kill time.
9. How does gender affect healthcare in a deployment setting? Are females and males treated differently with regards to health care in a deployment setting?
My battalion had about 3 females in it so I've never run into any situations where females were unable to receive health care.
10. How important is it in the health care systems to make accommodations to individual’s religious, and cultural preferences in a deployed setting? Are attempts made to understand and accommodate those individuals who come from different cultures and backgrounds?
I've personally never heard anyone complain that their cultural or religious needs were not being met with army health care.
11. In your opinion what areas and aspects of treating health and illness in deployed soldiers need improvement? This can include changes in ways of thinking and behaviors to actual physical changes to how treatment is given or how regulations are written. How would you change or fix these situations?
Better acclimation to environments you'll be deployed to or training in could help prevent a ton of environmental or physical injuries. Or in those situation communicated to higher and early evacuation of patients before their condition worsens or they cause harm or illness to others in your platoon.
Lang, J. W. (2016, June 12). Health and Illness in Soldiers. (C. Wilken, Interviewer)
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