The Defense Health Board hosted a virtual meeting on June 4, 2024, to discuss projects and initiatives related to improving health care in the Department of Defense.

The board’s mission is to provide independent advice and recommendations to maximize the safety and quality of, as well as access to health care for DOD beneficiaries.

Dr. Karen Guice is the president of the Defense Health Board, and U.S. Navy Capt. Shawn Clausen is its executive director and designated federal officer.

The meeting featured briefings about the Health of the Force Report and a pilot program from the National Center for Disaster Medicine and Public Health. Health experts presented Defense Health Board reports on effective public health communication strategies in the DOD and on prolonged theater care.

COVID-19 Pandemic Revealed Need to Improve Public Health Communication

Dr. Wilsie Bishop, chair of the Defense Health Board public health subcommittee, presented on the progress of a report titled, “Effective Public Health Communication Strategies with Department of Defense Personnel.”

Bishop explained that the Defense Health Board was asked to “identify lessons learned about the DOD’s vulnerabilities and capabilities in disseminating health information during the COVID-19 pandemic.”

“Health communications during the COVID-19 pandemic occurred in an exceptionally challenging social and informational environment,” said Bishop. “A voluminous amount of health information of varying veracity and quality was accessible through news and social media.”

“An epidemic of competing information spread rapidly through social media. This included misinformation, which is false or inaccurate information and disinformation which is deliberately intended to mislead,” she said. “The DOD was not immune to these societal and information-related challenges. It now seeks to learn and prepare for future health challenges in the new information environment.”

The Defense Health Board was asked to review policies and processes used for health communication and to look at best practices, academic, commercial, and government research to provide recommendations on how DOD could better deliver information and fight misinformation and disinformation.

“As we develop the report, we kept four guiding principles in the forefront of our work,” said Bishop.

Guiding principles of report that the Defense Health Board followed included:

• Time is of the essence.
• DOD health communication is military-specific but occurs within a complex and influential civilian communication environment.
• Trust is essential to messaging uptake and to successful misinformation and disinformation mitigation efforts.
• Communicators of health information must provide recommendations based on available evidence and facts at the time.

“When we are seeking to optimize health communication, we must think of what we want to say and how it's received,” said Bishop. “We must develop the message with attention to factors that impact how it will be received.”

Guidance on Better Integrating Military-Civilian Training Partnerships

Dr. John Armstrong, chair of the Defense Health Board trauma and injury subcommittee, discussed the importance of training partnerships in his presentation titled, “Prolonged Theater Care, Part 2.”

“In September 2023, we were asked by Assistant Secretary of Defense for Health Affairs Dr. Lester Martínez-López to recommend guidance on better integrating military-civilian trauma training partnerships in the context of prolonged theater care,” said Armstrong.

Prolonged theater care is considered the full spectrum and continuum of medical care provided by military medical and nonmedical personnel from point of injury to definitive care.

The project has three objectives:

• Review the curriculum and experience of current military-civilian trauma training partnerships
• Provide recommendations to best prepare DOD personnel at military-civilian trauma training partner sites for prolonged field care in near-peer conflicts
• Provide recommendations to better integrate military-civilian partnerships with attention to Click to closeDirect CareDirect care refers to military hospitals and clinics, also known as “military treatment facilities” and “MTFs.”direct care military treatment facility staffing and regional medical operations centers

Preliminary findings the team found include:

• There is no standardized definition for military-civilian trauma training partnerships.
• The services do not have a centralized office or point of contact to provide a service level synopsis of all military-civilian trauma training partnership site activity or performance.
• Combatant command requirements related to readiness of the medical forces are not fully captured in the Defense Readiness Reporting System.

Presentation of the 2023 Health of the Force

Dr. Lisa Ruth, chief of the population health reporting division at the Defense Centers for Public Health – Aberdeen, gave a presentation on the preliminary 2023 Health of the Force Report.

Health of the Force is a suite of products including an annual population health report documenting conditions that influence the health and medical readiness of service members.

According to Ruth, Health of the Force is designed to empower senior leaders with data, information, and context to improve the health, wellness, and readiness of service members. It is also used to advance programs and policies that reduce and prevent illness and injury.

Ruth noted that once a U.S. Army-only product, with the organizational transition to the DHA, the scope of products has been expanded.

“Moving forward, we're going to include population health data for not only the U.S. Army, but also the U.S. Navy, the U.S. Air Force and the U.S. Marine Corps,” Ruth said. “We've partnered not only with the Armed Forces Health Surveillance Division, but other public health enterprise assets to really try to design an inclusive Health of the Force report that includes the best aspects of all legacy products, as well as some newly developed metrics that we built together.”

Some of the outcomes Health of the Force provides to service members and senior leaders include metric pages, spotlights on emerging issues and programs, site profiles, and an online version of the initiative, which is CAC-enabled.

Discussion of the National Disaster Medical System Pilot Program

Dr. Jeffrey Freeman, director of the National Center for Disaster Medicine and Public Health at the Uniformed Services University, gave a presentation of the center’s National Disaster Medical System pilot program.

Established in 2008, the National Center for Disaster Medicine and Public Health was established to advance the Nation’s medical and public health readiness for disasters, and is a partnership between the DOD, Department of Health and Human Services, Department of Homeland Security, the Department of Transportation, the Department of Veterans Affairs, and the Department of State.

“Our job principally is to advance the nation's medical and public health readiness for disasters, from a science, education, and training perspective,” said Freeman.

The National Disaster Medical System is a federal program established in 1984 to meet the substantial medical requirements of large numbers of military casualties returning home from an overseas conflict. To date, it has never been fully activated for this purpose and poorly prepared to meet this mission, according to Freeman; this was the motivation for the creation of the NDMS pilot program by Congress in 2020.

The NDMS as presently constructed has three primary missions—medical response, patient movement, and definitive care.

The NDMS pilot is working to assess and strengthen the NDMS to carry out its primary missions in support of a large-scale combat operation or other catastrophic event in the homeland. In doing so, the pilot program must establish partnerships with public and private health care organizations, ensure coordination with the federal interagency, and be conducted over five years at no less than five sites.

The initial pilot sites, chosen by a federal interagency working group, include Sacramento, California; Denver, Colorado; Omaha, Nebraska; San Antonio, Texas; and Washington, DC and the surrounding National Capital Region.

NDMS Pilot program activities include:

• Site projects designed to develop, test, validate, and scale potential solutions aimed at improving the capacity and interoperability of the National Disaster Medical System
• National studies investigating key constraints and identifying areas of opportunity for meeting the medical requirements of a large-scale combat operation
• Pilot exercises, which include tabletop, functional, and full-scale exercises, to identify needs and assess the effectiveness of adopted solutions

“Our objective is to achieve a sustainable model for military and civilian medical readiness by strengthening interoperable partnerships and enhancing the capacity and agility of the National Disaster Medical System,” said Freeman.

The next meeting of the Defense Health Board will be Sept. 4, 2024, in Falls Church, Virginia.