Executive Agency** MILVAX (NCR) Army Institute of Public Health++ (APG, MD) Technical Portfolios. Laboratory Sciences (LAB) Portfolio

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(JB San Antonio, TX) Food Analysis & Diagnostic Lab PHCD-Fort Hood PHCD-Fort Gordon DoDMWDVS (Fort Meade, MD / Fort Belvoir, VA) PHCD- Fort Belvoir PHCD- Fort Knox, PHCD- Fort Eustis (JB

Subordinate Command Executive Agencies/Administrative Control Strategic (Landstuhl, Germany) Veterinary Lab Europe PHCD-Southern Europe PHCD-Northern Europe Dog Center Europe Regional Command VETSVC

System of Health. BRIEFING OUTLINE PURPOSE: To provide an overview on the US Army Public Health Command. Dean G. Sienko, M.D., M.S. Commanding General, US Army Public Health Command US Army Public

Operation Tomodachi September 27, 2013 9/24/2013 2 Communicable diseases Why do we need Public Health?

Hygiene Laboratory, Johns Hopkins University 1776- General Washington vaccinates the Continental Army against smallpox 1982 - The Armed Forced Pest Management Board recommends the use of permethrin

1 (JB San Antonio, TX) Food Analysis & Diagnostic Lab PHCD-Fort Hood PHCD-Fort Gordon DoDMWDVS (Fort Meade, MD / Fort Belvoir, VA) PHCD- Fort Belvoir PHCD- Fort Knox, PHCD- Fort Eustis (JB Lewis-McChord, WA) PHCD-Fort Carson PHCD-San Diego PHCD-JB Lewis-McChord (Camp Zama, Japan) PHCD-Central Pacific PHCD-Western Pacific PHCD-Korea PHCD- Japan Blue Purple Red Gold Green Major Subordinate Command Executive Agencies/Administrative Control Strategic (Landstuhl, Germany) Veterinary Lab Europe PHCD-Southern Europe PHCD-Northern Europe Dog Center Europe Regional Command VETSVC Area or Installation Executive Agency** AFHSC (NCR) Executive Agency** MILVAX (NCR) 9/24/2013 The US Army Public Health Command: Leading Army Medicine s Transformation from a Health Care System to a System of Health. BRIEFING OUTLINE PURPOSE: To provide an overview on the US Army Public Health Command. Dean G. Sienko, M.D., M.S. Commanding General, US Army Public Health Command US Army Public Health Command Demographics and Global Reach Command Accomplishments Performance Triad Environmental Health Engineering Occupational and Environmental Medicine Health Risk Management Toxicology Operation Tomodachi September 27, /24/ Communicable diseases Why do we need Public Health? Environmental Pollution, Workplace Hazards and Injuries Social health and lifestyle USAPHC History Future Initiatives 1942: Army Industrial Hygiene Laboratory, Johns Hopkins University General Washington vaccinates the Continental Army against smallpox The Armed Forced Pest Management Board recommends the use of permethrin as a military clothing treatment. 1945: Moved to Chemical Warfare Center, Edgewood, MD 1960: Became U.S. Army Environmental Hygiene Agency (USAEHA) 1995: USAEHA formed basis for the U.S. Army Center for Health Promotion and Preventive Medicine (USACHPPM) 2009: USACHPPM became USAPHC (Prov) U.S. Army Center for Health Promotion and Preventive Medicine responds to 9-11 incident at Pentagon and to anthrax at Federal post offices and Hart Senate Office Building Ft Hood shooting and Behavioral Health Epidemiological Consultations Gulf of Mexico Oil spill. Investigated dispersant and hydrocarbon levels in seafood Public Health Command created Public Health Command response to Japanese earthquake National Prevention Strategy signed by the President of the United States Shoulder-To-Shoulder: No Soldier Stands Alone 2010: USAVETCOM attached to USAPHC 1994:U.S. Army Veterinary Command (USAVETCOM) activated with HQ at Ft. Sam Houston Texas 1980: Army Veterinary Corps became the Executive Agent for DoD Veterinary Service 1973: DCVS positions established within HSC 1916: Army Veterinary Corps established 9/24/ MISSION STATEMENT: Promote health and prevent disease, injury, and disability of Soldiers and military retirees, their Families, and DA Civilian employees; assure effective execution of full spectrum veterinary service for Army and DoD Veterinary missions. Commander COMMAND GROUP MG Dean G. Sienko FPPM* POPM (NCR, APG, JB San Antonio) USAPHC Headquarters (APG, MD) CSM CSM Gerald C. Ecker COS Deputy Commander for Veterinary Services COL Dennis C. Brown COL Erik Torring PHC Region-South PHC Region-North PHC Region-West PHC Region-Pacific PHC Region-Europe Army Institute of Public Health++ (APG, MD) Technical s Director, Army Institute of Public Health Mr. John Resta Epidemiology & Disease Surveillance (EDS) Laboratory Sciences (LAB) NOTE: Installations specified in parentheses represent the command group location, not units conducting short or longterm split operations, e.g. HQ, PHCR- North, and PHCR-Pacific. * USAPHC Commanding General dualhat as the Functional Proponent for Preventive Medicine ** Executive agencies receive administrative support from USAPHC, but the Army Surgeon General oversees them ++ Director dual-hat as Deputy to the Commander for Public Health Environmental Health Engineering (EHE) Health Promotion & Wellness (HPW) Health Risk Management (HRM) Occupational & Environmental Medicine (OEM) Occupational Health Sciences (OHS) Toxicology (TOX) Program 51 Army Hearing Program Program 63 Tri-Service Vision Conservation and Readiness Program 64 Environmental Medicine Color Legend Level of PH Services Veterinary Services (VET) Program 65 Occupational Medicine Program 66 Surety Medicine Program Program 9/24/ /24/

Personnel/Budget USAPHC Support Worldwide Personnel as of 1 MAR 2013 (3,356) Budget as of 1 MAR 2013 Military 1460 (44%) Contractor 216 (7%) Civilian 1023 (30%) NAF 582 (17%) FY12 Executed $

2 Personnel/Budget USAPHC Support Worldwide Personnel as of 1 MAR 2013 (3,356) Budget as of 1 MAR 2013 Military 1460 (44%) Contractor 216 (7%) Civilian 1023 (30%) NAF 582 (17%) FY12 Executed $ (million) DHP $ Reimb. $ 15.6 OCO $ 8.7 FY13 Planned $ (million) DHP $ Reimb. $ 12.1 OCO $ 15.3 Local Nat l 75 (2%) NOTE: FY 12 DHP Execution includes one time project funding. 9/24/ /24/ Crunching the numbers , , , , 860 2,908 1,956 5,000+ $7 million 2,900+ 7, ,000+ 7,272 4,968 4,608 3, Persons deployed to 100 countries Military public health policy regulations developed Training courses/workshops presented Oral/poster presentations Peer-reviewed publications Technical survey reports for customers In-depth project studies completed Short survey reviews conducted Epidemiological consultations/field investigations Disease and health conditions of military interest monitored Disease/health conditions monitored and reported Laboratory samples processed Toxicology technical reports Toxicity clearance Privately owned animal care visits Number of military working dog patients Commercial sanitation units Instillation food activities supported Value of operational rations inspected Ectoparasites (ticks, fleas, etc.) identified Tests for disease pathogens (viruses, bacteria, etc.) Arthropods identified Fitness assessments Metabolic assessments Wellness education classes Blood pressure screenings Biofeedback sessions Performance Triad: Fundamental to the transformation to a System of Health 9/24/ Objectives: Screen Soldiers for injury risk Decrease unit injury rates Increase awareness and good decision making concerning healthy activity Physical Therapist s role in Performance Triad: Lead working group to develop educational products Coordinate injury risk assessment Provide squad leader training Coordinate Physical Therapy support Activity Weekly messaging: Sit Less and Move More Preventing Injuries Safe Running Prepare to Perform Resistance Training Extreme Conditioning Programs (Examples include CrossFit, P90X, and Insanity ) Objectives Increase awareness of optimal nutrition practices Promote and foster positive nutrition behaviors Support and sustain unit nutrition program RD s role in Performance Triad SME to unit level trainers Assess and improve eating environment Provide Army MOVE! and MNT based on unit needs Nutrition Weekly messaging Eat for Performance Nutrient Timing for Performance My Daily Nutrition Performance Plan Be Smart About Dietary Supplements Be Smart About Energy Products Mission Specific Nutrition Guidelines 9/24/ /24/

Objectives Increase awareness of healthy

Promote and foster healthy sleep habits.

Sleep Core messages: Sleep 7-8 hours for

Sleep is critical for the brain s complex

Transforming mindset from I don t have enough

critical commodity that my Soldiers and I

Caffeine is OK but go caffeine-free 6 hours

Sleep planning is a leader s responsibility

APG Army Wellness Center First AMC Stress

Engineering (EHE) Shoot House Lead Exposure

3 Objectives Increase awareness of healthy sleep requirements. Promote and foster healthy sleep habits. Support and sustain healthy sleep and sleep reset. Sleep expert s role in Performance Triad: SME to unit level trainers SME to MTF staff Provide additional training to MTF staff Sleep Core messages: Sleep 7-8 hours for optimal performance. Sleep is critical for the brain s complex mental operations. Transforming mindset from I don t have enough time to get enough sleep to Sleep is a critical commodity that my Soldiers and I must have. Caffeine is OK but go caffeine-free 6 hours before bedtime. Sleep planning is a leader s responsibility during sustained operations. APG Army Wellness Center First AMC Stress Reduction with Biofeedback BOD POD 9/24/ /24/ Environmental Health Engineering 9/24/ Environmental Health Engineering (EHE) Shoot House Lead Exposure Assessment Mission: Assess, maintain and improve Soldier and Army Community environments to advance readiness, health and sustainability. Shoot houses are designed and built to mimic urban combat situations for realistic training. SKC Aircheck Sampler (Air Sampling Pumps) 9/24/ /24/

Air Sampling in Kuwait Water Supply Management & Surface Water

(MAAMS) Roof of Mobile Ambient Air Monitoring Station Left: Two

Reuse Efforts in Contingency Operations.

Portable air sampler (Joint Base Balad, Iraq) SPRING Producing

Calibration Rock Island Lead Exposure Assessment 9/24/2013 19

auditory fitness-for-duty standards Hearing Conservation

Hearing Services: Evidencebased, new technology acquisition

Services: Hearing/balance assessment, treatment, rehabilitation

education 9/24/2013 22 Tactical Communication and Protective

William Rice, Occupational and Environmental Medicine director,

Soldiers are evaluating TCAPS, a new hearing protection system

increase mission effectiveness, safety and survivability.

state noise (vehicle, aircraft, industrial operations) Provides

preserving ability to hear mission related sounds (Situational

localization Reduces ambient auditory situational awareness BOI

Awareness) Allows Soldiers to communicate in noisy environment

and localization of sounds Improves SNR; better auditory SA BOI

Dominator Peltor Com-Tac II Sound Transmission Earmuff

4 Air Sampling in Kuwait Water Supply Management & Surface Water and Wastewater Programs Mobile Ambient Air Monitoring Station (MAAMS) Roof of Mobile Ambient Air Monitoring Station Left: Two MiniVols and Right: Two MultiRAEs MiniVol Calibration Water Reuse Efforts in Contingency Operations. BP Oil Spill Deepwater Horizon Integrated Operations MiniVol: Portable air sampler (Joint Base Balad, Iraq) SPRING Producing Fresh Pure Water from Unauthorized Water Sources MultiRAE Calibration Rock Island Lead Exposure Assessment 9/24/ /24/ Hearing Readiness: Develop hearing profiles and auditory fitness-for-duty standards Hearing Conservation Program Four Components of Army Hearing Program Operational Hearing Services: Evidencebased, new technology acquisition Occupational and Environmental Medicine Clinical Hearing Services: Hearing/balance assessment, treatment, rehabilitation Hearing Conservation: Noise mitigation, hearing protection, education 9/24/ Tactical Communication and Protective Systems (TCAPS) TCAPS Capabilities Comparison Col. William Rice, Occupational and Environmental Medicine director, demonstrates Tactical Communication and Protective Systems equipment for Lt. Gen. Patricia D. Horoho, Army surgeon general and MEDCOM commander. Soldiers are evaluating TCAPS, a new hearing protection system that will provide Soldiers with the situational awareness to increase mission effectiveness, safety and survivability. Non-Linear Earplug (Passive) Provides protection from steady state noise (vehicle, aircraft, industrial operations) Provides protection from impulse (weapons fire, blast, explosions) while preserving ability to hear mission related sounds (Situational Awareness) Does not address radio communications and localization Reduces ambient auditory situational awareness BOI to all Soldiers TCAPS (Active) Provides protection from steady state noise (vehicle, aircraft, industrial operations) Provides protection from impulse (weapons fire, blast, explosions) while preserving ability to hear mission related sounds (Situational Awareness) Allows Soldiers to communicate in noisy environment and access to radio systems while providing hearing protection and localization of sounds Improves SNR; better auditory SA BOI to Soldiers carrying Rifleman Radios Atlantic Signal / Phonak Dominator Peltor Com-Tac II Sound Transmission Earmuff 9/24/ /24/

Tri-Service Vision Conservation and Readiness Program

through vision conservation and readiness of Department

Universal Prescription Lens Carrier (UPLC)

Environmental Medicine Program delivers professional

deployment health issues to medical providers, MEDCOM,

Balad Air Force Base, Iraq: Burning uniforms that were

Army's eventually becoming the only Rx Carrier

Balad Air Force Base, Iraq Burn Pit at Bagram Air Force

Dichromate Exposure at Qarmat Ali Water Treatment Plant

provide professional consultative services in military

for America s Armed Forces and the Federal Government.

Military-Unique Exposure The primary concern is the

manufacture, storage, use, and disposal of IMs.

probability of exposure to both humans and ecological

9/24/2013 27 9/24/2013 28 Surety Medicine Program

5 Tri-Service Vision Conservation and Readiness Program Mission: Optimize vision, optical, and eye health through vision conservation and readiness of Department of Defense health care beneficiaries. Universal Prescription Lens Carrier (UPLC) Environmental Medicine Program Mission: The Environmental Medicine Program delivers professional consultative services related to environmental and deployment health issues to medical providers, MEDCOM, DoD and the Combatant Commands. Balad Air Force Base, Iraq: Burning uniforms that were exposed to bodily fluids. Recently selected as the U.S. Army's Universal Prescription Lens Carrier (UPLC) eventually becoming the only Rx Carrier platform used by U.S. Army military. Balad Air Force Base, Iraq Burn Pit at Bagram Air Force Base, Afghanistan 9/24/ /24/ Sodium Dichromate Exposure at Qarmat Ali Water Treatment Plant in 2003 Occupational Medicine Program Mission: We provide professional consultative services in military Occupational Medicine and Occupational Health Nursing for America s Armed Forces and the Federal Government. Insensitive Munitions Explosives (IMX): A Military-Unique Exposure The primary concern is the risk of human and ecological exposure to NTO during the manufacture, storage, use, and disposal of IMs. This concern poses unquantifiable risks to both DoD and civilian populations. NTO s high solubility in water increases the probability of exposure to both humans and ecological receptors. 9/24/ /24/ Surety Medicine Program Health Risk Management Radiation Assessment in the Hamden Scrap Metal Yard in Basra, Iraq. Timothy Merkel, Surety Medicine Program instructor, demonstrates key points of radiological patient assessment during an exercise. 9/24/

6 Health Risk Management (HRM) Mission: To provide comprehensive environmental health risk management guidance and support measures to worldwide Commanders, decision makers, Service Members, and Civilians for ensuring and enhancing readiness. Toxicology 9/24/ Toxicology (TOX) Mission: Promote health and prevent disease, injury and disability of Soldiers and civilians by specializing and identifying the toxicology of military unique and relevant compounds and the risks they pose to humans and the environment. TOX Capabilities Research Development Testing & Evaluation Computer Modeling In Vitro Assays In Vivo Animal Studies Toxicity Clearances Wildlife Toxicity Assessments Environmental Health Assessments 9/24/ /24/ Operation Tomodachi 9/24/

A magnitude 9.0 earthquake hit 43 miles off the coast of Japan on 11 March 2011. The earthquake was the most powerful to ever hit Japan and caused tsunami waves that reached up to 130 feet.

DoD Civilians 5000 Local Nationals 23,000 Worst impact was at the Fukushima Daiichi nuclear plant, which was severely damaged by the earthquake and subsequent tsunami waves.

7 A magnitude 9.0 earthquake hit 43 miles off the coast of Japan on 11 March The earthquake was the most powerful to ever hit Japan and caused tsunami waves that reached up to 130 feet. Military bases in Japan: Total (23) : Army (3 base clusters) Air Force (3) Navy (4) Marines (13) Personnel/Family Members/DOD Civilians/Local Nationals: Approximate: Military 47,000 Dependents 52,000 DoD Civilians 5000 Local Nationals 23,000 Worst impact was at the Fukushima Daiichi nuclear plant, which was severely damaged by the earthquake and subsequent tsunami waves. The earthquake, tsunami, and nuclear zone evacuation affected hundreds of thousands of residents. Operation Tomodachi, a United States Armed Forces assistance operation to support Japan in disaster relief began on March 12 Fukushima Dai-ichi, Reactor 3 on 14 March /24/ /24/ Critical Questions: Is the air safe to breathe? Is the water safe to drink? Is the food safe to eat? Is the environment safe for my family and I? Should we stay in Japan or leave? Is it safe for pregnant and lactating women? Is it safe for children to live here? Is it safe for my pets to live here? What are the long-term consequences of this exposure? Army Public Health Command Support to Operation TOMODACHI Pre-Deployment Assessment and Recommendations Deployment Activities Laboratory Support Occupational and Environmental Medicine Support Reach-back Support Risk Communication Support to PACOM End State: PHCR-PAC was left with an established radiological monitoring program, trained personnel and a workshop plan to educate the entire community. 9/24/ /24/ Sharing our OEHSA findings with Japan Ground Self Defense Force COL Suzuki The Way Ahead Radiation exposure to U.S. Forces and families residing in Japan are minimally above background levels, lower than in some U.S. cities, and is not expected to have any lasting effect on health. Operation Tomodachi registry has been started to help define and observe long-term risks for Servicemembers and Families. Environmental exposures and individual exposures for radiation, chemicals, asbestos, and silica is recorded in a DoD database and can be used to determine exposure. Greatest long-term risk is psychological. Plan in place for enduring monitoring, radiation laboratory capacity in Japan, and food approved source evaluation. 9/24/ /24/

Operation Tomodachi Registry Operation Tomodachi Registry was constructed to: Provide a record of individuals who were potentially exposure to radiation during

claims Support limited epidemiological studies or medical surveillance that may be warranted Phase 1 (April 2012): Location-based dose estimates completed for

dosimetry and/or internal monitoring data Individual can request their individual assessment via the OTR Website Fully operational registry within DOEHRS

Officer Occupational Health Nurse Health Physicist Animal Care Specialist Audiologist Meteorologist Psychologist Geologist Chemist Safety and Occupational Health

Social Worker Agronomist Toxicologist Electrical Engineer Dietitian Acoustical Engineer Wildlife Biologist Dental Officer Veterinarian Optometrist Epidemiologist

Industrial Hygienist Clinical Medicine Veterinarian Healthy Work Places Comparative Medicine Veterinarian Veterinary Food Inspection Specialist Environmental

8 Operation Tomodachi Registry Operation Tomodachi Registry was constructed to: Provide a record of individuals who were potentially exposure to radiation during Operation Tomodachi Support requests for information Inform clinical treatment and diagnosis Assist Departments of Veterans Affairs (VA) and Labor (DOL) with claims Support limited epidemiological studies or medical surveillance that may be warranted Phase 1 (April 2012): Location-based dose estimates completed for land-based population centers Establishment of the OTR Website Phase 2 (December 2012): Individual dose estimates completed for all individuals with personal dosimetry and/or internal monitoring data Individual can request their individual assessment via the OTR Website Fully operational registry within DOEHRS 9/24/ /24/ Breadth of Knowledge Laboratory Animal Veterinarian Sanitary Engineer Statistician Veterinary Pathologist Nuclear Medical Science Officer Occupational Health Nurse Health Physicist Animal Care Specialist Audiologist Meteorologist Psychologist Geologist Chemist Safety and Occupational Health Specialist Chaplain Medical Laboratory Specialist Ergonomist Fire Protection Engineer Healthy Community Entomologist Physicist Safety Engineer Medical Officer Social Worker Agronomist Toxicologist Electrical Engineer Dietitian Acoustical Engineer Wildlife Biologist Dental Officer Veterinarian Optometrist Epidemiologist Healthy Animals Healthy People Mechanical Engineer Environmental Engineer Community Health Nurse Environmental Law Attorney Marine Biologist Physical Therapist Industrial Hygienist Clinical Medicine Veterinarian Healthy Work Places Comparative Medicine Veterinarian Veterinary Food Inspection Specialist Environmental Scientist Veterinary Services Food Safety Officer Preventive Medicine Physician Environmental Protection Specialist John Resta/ /john.resta@us.army.mil UNCLASSIFIED 45 9/24/

U.S. Army Public Health Command (Provisional) Organization Overview and Environmental Health Engineering Services

U.S. Army Public Health Command (Provisional) Organization Overview and Environmental Health Engineering Services Donna M. Doganiero, CIH Director, Occupational Health Sciences 15 June 2010 Presentation