Psychiatric medevacs during a 6-month aircraft carrier battle group deployment to the Persian Gulf: A Navy force health protection preliminary report

Military Medicine, Jan 2003 by Wood, Dennis Patrick

When a U.S. Navy Aircraft Carrier battle group deploys overseas, the aircraft carrier's medical department is responsible for the medical needs of over 12,000 personnel with their indigenous developmental, stress, family, alcohol, drug, and interpersonal and intrapersonal relationship difficulties. This article reviews the effectiveness of having a U.S. Navy clinical psychologist and a psychiatric technician onboard the USS Carl Vinson, the flag ship of Vinson's battle group, during this battle group's 1998/1999 Persian Gulf deployment (i.e., Western Pacific Deployment). Importantly, these two individuals reported to the USS Vinson as permanent members of the ship's company. The clinical psychologist logged 448 individual outpatient-care consults and 79 individual consults with sailors who had a history of overusing or abusing alcohol. Additionally, nine sailors with acute disabling psychiatric diagnoses were hospitalized on the ship's medical ward, and four sailors were medically evacuated (medevaced), by fixed wing aircraft, from USS Vinson to a Navy Hospital in the United States for definitive evaluation, treatment, and disposition. These four medevacs were less than the number of medevacs from two previous Aircraft Carrier Battle Group Persian Gulf deployments. Importantly, these two previous WESTPAC deployments were made without having a clinical psychologist as a full-time member of the respective aircraft carrier's medical department. Providing clinical psychology/mental health services at the "tip of the spear" is an effective, beneficial, and cost-saving landmark improvement in providing quality medical care to the fleet.

Introduction

The rapid pace of change in Navy medicine continues unabated with operational health service support to sailors and marines being provided "at the tip of the spear."1 This new and evolving health care doctrine has been identified as Naval Force Health Protection (FHP), and this doctrine has been designed to define how Navy medicine will operate, at sea and ashore, in the new millennium.

Briefly, FHP is a "unified strategy designed to protect service members from all health and environmental hazards associated with military service."1 The three FHP "pillars" are a healthy and fit force, casualty prevention, and casualty care and management. A healthy and fit force is a necessary precondition for all other elements of FHP to function as designed. Components or building blocks of a healthy and fit force include but are not limited to: physical fitness training, health promotion programs, family support services, occupational health programs, periodic health assessments, stress management, and TRICARE.1

The purpose of casualty prevention is to counter two types of threats to health: disease and nonbattle injuries and the threat posed by the enemy. To prevent disease and casualties, FHP mandates a comprehensive medical intelligence system bolstered by continuous monitoring and surveillance and individual health screenings. These screenings are to take place before and after deployments, exposure to potential hazards is to be reduced and an aggressive immunization policy is to be maintained. Casualty care and management decrees "providing care is as responsive, simple and economical.... as possible ..."1

Psychiatric Morbidity in Sea Service Personnel

Psychiatric morbidity among sea service personnel represents measurable risks to the stability and functionality of all three of the FHP pillars. Psychiatric morbidity among sea service personnel has included personality, post-traumatic stress, eating, anxiety, and/or psychotic disorders, as well as psychoses and mood disorders with and without suicidal ideation, gestures, attempts, or completions.2-16 Alcohol abuse, dependency, and addiction disorders also represent measurable risks to a healthy and fit force, and casualty prevention due to the fact that these disorders continue to plague sea service members in crippling numbers.17 Lastly, the presence of psychiatric disorders in Navy recruits and sea service personnel measurably jeopardizes manning levels at both shore-based and sea-going commands.

Several studies have documented that a high percentage of male and female Navy recruits have histories of sexual and/or physical abuse during childhood and/or adolescence, and a high percentage of male recruits have perpetrated, attempted, or completed rape.4-6 Merrill et al.4 documented that not only were female Navy recruits, who were victims of sexual assault, at high risk for developing somatic and/or psychological problems that require treatment by military health care professionals, but they were also at increased risk of being sexually revictimized as adults. Male perpetrators of sexual assault were at high risk of repeating their behavior.4

More specifically, Merrill et al.5 also reported that "a relatively high number of both 1994 and 1996 basic male and female trainees entered Naval service with histories of childhood physical abuse, childhood sexual abuse, adult physical and sexual victimization, adult perpetration and physical and sexual aggression and alcohol misuse." Due to these high numbers of recruits with psychiatric difficulties and in the interest of breaking the cycles of sexual abuse and sexual predation and the cycles of alcohol use/misuse, it has been proposed that selected recruits be enrolled in various intervention programs during their recruit training.5,6