|
Testimony
of Ronald R. Blanck Before
the Subcommittee
on Health House
Committee on Veterans Affairs Regarding
Lessons
Learned from the Gulf War January
24, 2002 Mr.
Chairman and members of the Veterans’ Affairs Subcommittee, it is a
pleasure to be here today and share some observations with you.
I am Ronald R. Blanck, President of the University of North
Texas Health Science Center at Fort Worth, Texas and former Surgeon
General of the U.S. Army, having retired in July 2000. Following
the Persian Gulf War, investigations of the medical complaints of Gulf
war veterans were hindered because relevant records were often
inaccessible or nonexistent. Records
that were available often lacked uniformity and accuracy and were
generally not automated. At
least partly in response, “deployment medical surveillance” became
a priority of the Department of Defense.
Recent advances in information management technology have
enabled the development of a comprehensive public health surveillance
system for the US Armed Forces. The
Defense Medical Surveillance System (DMSS) is the central repository
of medical surveillance data for the US Armed Forces.
Data in the DMSS document statuses of and changes in
demographic and military characteristics (e.g., service, rank,
military occupation) of all servicemembers.
In addition, they document significant military (e.g.,
assignments, major deployments) and medical (e.g., ambulatory clinic
visits, hospitalizations, immunizations, deaths) experiences of
servicemembers throughout their military careers. The DMSS receives data from multiple sources and integrates
it in a continuously expanding relational database.
Longitudinal records are established and continuously updated
for all individuals who have served in the Armed Forces since 1990. All records
in the DMSS are maintained in person, place and time frames of
reference. The
maintenance of person, place, and time relationships in the database
permits, for example, nearly instantaneous assessments of the
morbidity experiences of servicemembers who shared characteristics,
were in specific locations, or had similar experiences on days or
during periods of interest since 1990.
The following are examples of the types of routinely collected
data available in DMSS: Major
deployments: Since the Persian Gulf War, each Service has been
required to document the participation of its members in specified
major deployments. Electronic
files listing participants in designated deployments—with start and
end dates of each individual’s participation—are provided by the
Services to the Defense Manpower Data Center, which in turn provides
the data to the DMSS. Currently,
more than 1.2 million records document the participation of
individuals in major overseas deployments.
Pre- and post-deployment
health assessments: Pre- and post-deployment health assessments
are used to assist the medical staffs of deploying and returning
forces to identify the medical concerns of deployers at early clinical
stages. Brief,
standardized, self-administered questionnaires solicit categorical
responses to questions regarding medical history, general health, and
system-specific signs and symptoms.
More than 435,000 pre- and post-deployment health assessment
records are integrated in the DMSS.
Hospitalizations (in
fixed military medical facilities): Since January 1990, records of
all hospitalizations of active duty servicemembers in US military
hospitals have been integrated in the DMSS.
Each record documents up to eight discharge diagnoses that are
coded using the International Classification of Disease, ninth
revision, clinical modification (ICD-9-CM).
The causes of injuries that result in hospitalizations are
reported using standard North Atlantic Treaty Organization (STANAG)
external cause of injury codes. In
December 2001, more than 1.9 million hospitalizations of active duty
servicemembers were documented in the DMSS.
Ambulatory visits (to
fixed military medical facilities): Since approximately 1997,
records of ambulatory visits of active duty servicemembers have been
integrated in the DMSS. Each
ambulatory visit record documents primary and up to three alternate
diagnoses using the ICD-9-CM. In
December 2001, more than 59.3 million ambulatory visits of active duty
servicemembers were documented in the DMSS database.
Serologic Specimens:
Servicemembers are routinely screened for antibodies to HTV-1 during
pre-induction and periodic medical examinations, prior to overseas
assignments, and before and after major overseas deployments.
Since approximately 1990, serum remaining after routine HIV-1
antibody testing and sera collected before and after major deployments
have been forwarded to the DoD Serum Repository (DoDSR).
At the repository, specimens are stored in precisely documented
locations in walk-in freezers at –30ºC.
In the DMSS, serum identification numbers and repository
locations are linked to dates of specimen collection and to personal
identifiers of donors. More than 27 million serum specimens related to over 7.1
million individuals are currently stored in the DoDSR.
Approximately 4.5 million individuals (60.5% of the total) have
at least two specimens in the repository.
The DoDSR adds a unique and powerful seroepidemiologic
surveillance capability to the overall military medical surveillance
program. Contact Information: Further information regarding the availability, use or interpretation of data contained in DMSS or access to specimens in the DoD Serum Repository may be directed to the staff at the AMSA (202) 782-0471 (DSN: 662). POC:LTC(P) Mark Rubertone, MC, USA, Chief, Army Medical Surveillance Activity, US Army Center for Health Promotion and Preventive Medicine, (202) 782-0471 (DSN:662), e-mail: mark.rubertone@amedd.army.mil. Back to Witness List |