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The Army has experienced a dramatic increase in opioid use, misuse, and addiction since 2001, with nearly 14% of soldiers prescribed opioid pain medication as of 2010. These levels adversely impact force readiness, Army death rates, and overall soldier health. The Army response has been uncoordinated, with the medical branch framing widespread opioid use as a medical issue, Army leadership deeming it the result of risk taking soldiers and poor leadership, and the legal branch addressing it as a disciplinary issue. Opioid use is a new threat environment created by changing medical views on pain treatment, unique wartime drivers that render soldiers particularly susceptible to opioid abuse, and military culture. The Army must review this issue anew to develop an effective response. Army policies, using Vietnam era drug enforcement methods, are failing to mitigate the problem. Preventative policies such as medical monitoring of soldiers prescribed opioids, opioid risk training, and removing stigma for those seeking opioid abuse help are needed to reverse the problem. Erroneously framing the threat as primarily a disciplinary issue is perpetuating misuse and harming soldiers, force readiness, and civilian communities.

Strategic leaders and planners can take advantage of the U.S. military capability -- its means -- to establish an expeditionary medical system with sixty-minute evacuation response times to pick up wounded at the point of injury. This strategic research project (SRP) argues that our federal government must mandate the sixty-minute standard as national security policy. Furthermore, to export this professionalism, our senior leaders must encourage our allies and partners to adopt our same standard. The policy must be a requirement for this nation's participation in coalitions or alliances. The range of U.S. military gains attending Secretary Gates' initiative are a useful case study to highlight the challenges and potential strategic benefits that can result from this achievement.

The health of Americans is a vital national interest. Despite the considerable resources devoted to healthcare, the US falls short of achieving optimal health. A strategic assessment shows this gap is due to disproportionate resource allocation to healthcare delivery. Historic strategic attempts to improve health through preventive strategies suffer from similar misalignment of ends, ways, and means. Future health strategies must more fully address governance, health resourcing, and health information. Health information is a strategic asset and a key enabler for effective health management. Although healthcare information is a subset of overall health information, current sources of health information are predominately sourced from healthcare delivery organizations. Development of information sources that reflect the broader determinates of health are needed. The challenges to achieving comprehensive health management include the current focus on healthcare delivery and the resultant limited patient treatment information collected. Improvement of health governance and establishing a broad-based health information architecture are the first steps toward achieving optimized health.

Army Medicine, to combat the rising cost of health care, the increasing rate of preventable diseases, and the diminishing pool of eligible military recruits due to health related issues, is transforming from a health care system to a System for Health. The focus is shifting from a disease-based model to a preventive model of care. Although Army Medicine is changing practices and implementing health-focused initiatives to facilitate this paradigm shift, barriers inherent in the organization remain and are hindering the transformation process. Institutionalizing this new paradigm requires eliminating the cultural, economic, and educational barriers by providing tools and appropriate resources, implementing methods for promoting healthy lifestyles, and leveraging education, research, and technology. Transforming Army Medicine from a health care system to a System for Health has the potential to positively influence Army Medicine, the Military Health System, and ultimately shape health care in the nation.

"Soldier, family member, and Army resiliency is the cornerstone of future Army psychological health. Current resiliency is strong and growing stronger through the many programs and systems in the Army. Many of these were developed during the conflicts in Iraq and Afghanistan. This research paper reviews the existing programs and recommends continued support to the programs that have proven successful. In the end, the U.S. Army and its Soldiers and families deserve the best resiliency programs available, and the Army can continue to do this even in a financially challenged situation. The Army continues to move towards the social media environment with the Army OneSource program. Last, Army leaders must consider future resiliency programs as we rebuild informal resiliency programs if and when formal programs are discontinued with future fiscal constraints."--Abstract.

"Over the last decade the U.S. Department of Defense (DoD) has witnessed a dramatic increase in service member's deaths by suicide. The cause of this increase is the center of much debate within the U.S. Army and the Department of Defense. Underlining the increase in death by suicide is the stress twelve years of constant combat in Iraq and Afghanistan has, and continues to cause service men and women. This paper will examine the causes of suicide as interpreted by the U.S. Army and the preventive measures the U.S. Army is taking to address suicide within its ranks. It will then discuss the theory of suicide from a social-psychological prospective followed by a discussion of how the U.S. Army's Force Generation (ARFORGEN) model and a lack of professional military education in the noncommissioned officer ranks have led to the inadequacies of U.S. Army's small unit leadership in dealing with suicide prevention. The paper will conclude with a recommendation for how the U.S. Army can correct small unit leadership deficiencies, thus better preparing first line leaders on combating suicide."--Abstract.

"The purpose of this study was to determine the agreement between the Centers for Disease Control and Prevention (CDC) definition and the clinical judgment of a board-certified neurologist based upon medical records review, and to utilize a historical prospective design in a large, well documented United States Air Force (USAF) population to determine possible performance and health decrements among USAF service members who have been diagnosed with mild traumatic brain injury (mTBI). The scope of this study includes all active duty USAF men and women who served for six or more months during October 1, 2001 through September 30, 2008. The study included 518,893 Airmen with 5,065 (or almost 1%) who meet the CDC definition of mTBI. The results of this study are important in understanding the possible adverse performance and health decrements associated with mTBI."--Abstract.

"Chairman Graham and distinguished members of the Committee, thank you for inviting me to testify today on present and future costs of defense health care. It is an honor and pleasure to be here. My testimony will briefly discuss cost trends in Defense health care and then focus on two areas in which the Department of Defense might consider making changes: (1) TRICARE benefit design and (2) organizational structure of the Military Health System."--Abstract

"One of three strategic goals on the US Army Medical Department (AMEDD) Balanced Score Card is to protect and sustain a healthy and medically protected force. Outcomes that measure this objective are healthy soldiers protected from injury and disease throughout their assignment lifecycle. In the last decade many strides have been made to maximize health, fitness, and medical preparedness of forces being deployed, while minimizing disease and injury risks during deployments. Although, today we have a broader understanding that the successful execution of this strategy depends on the effective conduct of comprehensive military medical surveillance (CMMS), the Army has made considerable efforts in various areas and in response to the demand has responded with several medical and health surveillance initiatives. This research paper will provide an overview of Department of Defense (DOD), Army and AMEDD interim electronic outpatient records in place and their current application and will discuss the Longitudinal Health Risk Assessment Program (LHRAP) and provide recommendations. The LHRAP is a proposed evidence-based screening and risk reduction program designed to decrease morbidity and mortality associated with chronic health risks such as hypertension, hyperlipidemia, and smoking. The program addresses cardiovascular and cancer risks for active duty soldiers aged 35 and older"--Abstract.

Discusses whether the Department of Defense regional managed care program TRICARE is available to state employees who are activated reservists or National Guard members and their spouses and dependent minor children, and if TRICARE benefits are the same as state employee benefits.

"Qui Nhon, South Vietnam: Pfc. Gregory Hatliff gives medical treatment to a Vietnamese baby with sores on his head. The peaceful moment came during a pause in Operation Black Horse in this area."