TRIPLER Army Community HospitalCommunity
Public Health Command-Pacific
Public Health is Force Health Protection
Public health is the science and art of preventing disease, prolonging life, and promoting physical health through organized, population-focused efforts. While clinical medicine focuses on treating individual patients, public health centers on proactively protecting the community through a broad range of health-related fields, issues, and initiatives. Within the Regional Health Command-Pacific (RHC-P) area of responsibility (AOR), Public Health Command-Pacific (PHC-P) provides comprehensive public health support to protect the force, promote health, and prevent disease and injury. Recognizing the interrelated and overlapping interactions of people, animals, and environment, PHC-P works to maximize readiness through a “One Health” concept* across the RHC-P AOR. To address critical areas impacting health and military readiness requires, PHC-P is organized around seven service lines, plus Global Health Engagement:
ANIMAL HEALTH AND FOOD PROTECTION
As the Department of Defense (DOD), Executive Agent for all veterinary services, the Army Veterinary Corps provides medical care for military working dogs (MWD), ceremonial horses and mascots, and even dolphins and sea lions supporting the U.S. Navy Marine Mammal System’s program.†
Operating 32 veterinary treatment facilities (VTF) in the RHC-P AOR, PHC-P provides more than 1,000 MWDs and other GOAs comprehensive care. Additionally, PHC-P provides veterinary medical care for nearly 120,000 privately owned animals. Through this care, veterinarians maintain their clinical skills and improve the health of DOD families. Other services include training MWD handlers to perform immediate medical care, the canine tactical combat casualty care, emergency care, and routine veterinary preventive medicine. PHC-P also provides veterinary medicine subject matter expertise supporting other agencies and foreign governments. In order to address critical zoonotic disease control issues, PHC-P veterinarians lead or support rabies control and animal bite investigations, import quarantine inspections, communicable animal disease surveillance, and support installation animal facilities. Finally, PHC-P manages a First Year Graduate Veterinary Education (FYGVE) Program, located within Public Health Activity-JBLM (PHA-JBLM) training four to six veterinary interns each year.
Given their expertise in microbiology, epidemiology, pathology, and public health, veterinarians are the logical choice for inspecting and ensuring the quality of food. Food protection is a core veterinary mission that includes food quality (measurable characteristics consumers value like flavor, texture, etc.), food safety (food, water, and ice are safe and wholesome to consume), and food defense (preventing intentional contamination or adulteration with the intent to cause harm). All six PHC-P subordinate activities (Guam, Hawaii, JBLM, Japan, Korea, and San Diego) perform these duties – supporting large installations and remote sites such as Singapore, Diego Garcia, Kwajalein, and Antarctica. Warrant Officers manage food protection programs such as monitoring and coordinating responses to food recalls, conducting installation food vulnerability assessments, food and water risk assessments, ship rider support, approval of commercial food storage and production facilities, and laboratory food analysis.
CLINICAL PUBLIC HEALTH AND EPIDEMIOLOGY
The PHC-P Clinical Public Health and Epidemiology (CPH/EPI) service line provides expertise on surveillance and control of contagious diseases, injuries and occupational illnesses. Their services include: medical and biosurveillance monitoring and consultation; disease outbreak response assistance; force health protection guidance; expertise supporting Humanitarian Assistance/Disaster Response operations; and recommendations for disease prevention and control programs. Recent examples of CPH/EPI support include: Middle East respiratory syndrome coronavirus (MERS-CoV) in South Korea; Nepal earthquake; Leptospirosis in Okinawa; Dengue in Tokyo; Electronic Surveillance System for the Early Notification of Communitybased Epidemics (ESSENCE) application assistance; Lightning Rescue Pandemic Scenario in Palau; Hepatitis A outbreak on Oahu; and UN Peacekeeper Force Health Protection Program Development in Bangladesh and Nepal.
The Environmental Health (EH) service line provides support and technical assistance to military installations and units in deployed settings primarily through site visits and desktop consultations. The EH subject matter experts (SMEs) support a diverse array of programs including drinking water management and protection; emergency response; water resource management and pollution prevention (encompassing groundwater, wastewater, surface water, and stormwater); general facility sanitation; waste management, involving hazardous and regulated medical waste, process mapping, lab waste characterization, and management plan reviews and development; and entomological sciences, which covers pest management program reviews and support, and arthropod and rodent identification, collection, and testing.
HEALTH PROMOTION AND WELLNESS
The Health Promotion and Wellness service line focuses on three primary missions: 1) support readiness in garrison and deployed environments; 2) provide responsive and evidence-based public health nursing services; and 3) promote health, wellness, and disease prevention. See figure.‡ Services include epidemiological consultation and investigation; communicable disease surveillance and prevention; Force Health Protection (i.e. immunization programs); and deployment health. Additional, non-clinical services include: community health status assessments; health education and promotion; tobacco-free living initiatives; child health, safety, and well-being assurance; public health emergency consultation; and public health policy development consultation.
With locations in Japan, Hawaii, and Washington state, PHC-P maintains robust laboratory capacity to provide responsive, comprehensive testing and analysis supporting occupational and environmental health assessment and medical surveillance. The scope of laboratory analysis within PHC-P includes testing and analyses of drinking and bottled water, wastewater, solid/hazardous waste for metals, environmental lead, and food pathogen detection. Additionally, PHC-P labs can test for mosquito, tick, and rodent-borne diseases providing analytical data supporting enhanced surveillance efforts, risk identification, and threat mitigation of diseases of interest such as Zika, dengue, chikungunya, malaria, etc.
PUBLIC HEALTH INFORMATION
Public Health Information (PHI) provides environmental health “sustainment” training and assistance to both deployed and garrison preventive medicine (PM) assets throughout RHC-P AOR in order to ensure Service Members maintain a high level of technical proficiency in their PM duties. Major PHI training initiatives include: Defense Occupational Environmental Health Readiness System (DOEHRS); Deployment Occupational & Environmental Health Site Assessment (DOEHS); food and water safety and sanitation; field preventive medicine unit training; field sampling and analysis; industrial hygiene; and vector-borne disease surveillance.
WORKPLACE HAZARD ASSESSMENT AND CONTROL
The Workplace Hazard Assessment and Control (WHA&C) Service Line includes Health Physics (HP) and Industrial Hygiene (IH). PHC-P HP focuses on X-ray system compliance surveys and shielding evaluations of medical, dental, and veterinary treatment facilities, Radiation Protection Program reviews and safety consultations. PHC-P IH focuses on anticipating, recognizing, evaluating, and controlling occupational health hazards and exposures to prevent workplace injuries and illnesses. Its personnel provide advice in personal protective equipment (PPE) requirements, recommendations, and use. PHC-P IH provides a range of assessments and training. They conduct ventila-tion system assessments on specialized systems, such as welding hoods, paint booths, and carpentry shop systems. IH professionals lead comprehensive indoor air quality assessments such as monitoring for formaldehyde off-gassing from building materials, bio-aerosols, and allergens. Focusing on standardizing data, and policy and SOP development, the IH team provides training and support for DOEHRS-IH. They also conduct shoot house and firing range assessments (including their associated ventilation system surveys), noise studies (including octave band analysis). PHC-P IH professionals also offer facility design reviews to ensure new facilities and/or renovations comply with criteria such as life safety code and ventilation requirements.
GLOBAL HEALTH ENGAGEMENT
The PHC-P global health engagement officer helps synchronize PHC-P personnel participating in multiple bilateral and multilateral engagements. International SME exchanges allow PHC-P personnel to collaborate while building partner-nation capacity. PHC-P supports multinational exercises such as Balikatan (Philippines), Cobra Gold (Thailand), Talisman Saber (Australia), Yama Sakura (Japan), Yudh Abyhas (India), National Science Foundation efforts in Antarctica, and Pacific Partnership (multi-national tour) through food inspections, veterinary medicine care and training, environmental health and industrial hygiene assessments. Many engagements help build and refine disaster response preparedness such as the recent rehearsal of concept drill for evacuation operations for the Republic of Korea. During the 2016 Asia Pacific Military Health Exchange in Malaysia, PHC-P SMEs provided informational posters and briefings on veterinary medicine, water systems engineering, field preventive medicine, and disaster response. Another excellent example of the support PHC-P provides was Indonesia’s rabies eradication effort during Pacific Partnership 2016. Working in concert with senior Indonesian leaders, Army veterinarians vaccinated stray dogs in the city of Padang and participated in radio interviews to discuss pet vaccinations. Local officials praised PHC-P and Army medicine in general for their contribution to local eradication. PHC-P takes very seriously its mission to promote health and well-being. Its public health professionals work hard to protect the readiness of the force throughout the RHC-P.
Veterinarians Teach Dog Bite Protection
By Kirstin Grace-Simons
Regional Health Command-Pacific
JOINT BASE LEWIS-MCCHORD, WA– According to the Centers for Disease Control and Prevention (CDC), in 2013, 4.5 million people in the U.S. were bitten by a dog. The CDC estimates that 20 percent of the bites were serious enough to require medical attention. Half of those bites were suffered by children under 18 years of age. Injury rates from dog bites are highest among children 5-9 years of age. That is why Maj. M. Todd French, an instructor with the First Year Graduate Veterinary Education (FYGVE) program with Public Health Command District–Joint Base Lewis McChord (PHCD–JBLM), Washington, has his sights set on the area’s first graders.
French figures first grade is the perfect time to get kids informed on how to deal with dogs in order to prevent bites. He also sees this program as a platform from which to teach and connect with the community.
Erin Frie’s class had a short period of classroom instruction from veterinarians French, Capt. Eliza Zamor, Capt. Judith Kovach, and Capt. Petra van Moorsel, all interns in the FYGVE program. French, with permission, uses material from the University of Tennessee College of Veterinary Medicine, his Master in Public Health alma mater, including a video with an animated mascot, Rufus. “It’s a slam-dunk program; kids love it,” French said.
Once the kids learned the basics, it was time to meet the dogs. Rhoda Granum is a parole officer at the base’s correctional facility. She is also a volunteer with Canine Companions for Independence, Puget Sound Chapter, and coordinates the companion animal training program at the facility. On a pleasant day in late April, she was the handler of two golden retriever-yellow lab mixes, Alex and Penne.
Granum and the vets helped the students review the strategies they had learned to approach or avoid dogs. They practiced their skills in avoiding any dog they do not know or may find aggressive. The kids ignored the dogs attempts at gaining their interest and also demonstrated the proper technique for approaching and petting a dog. The kids easily applied what they were taught. The veterinarians were clearly good teachers.
One Health – the interaction between humans, animals, and the environment – is a central focus of Army Public Health. “As veterinary corps officers, amongst our other duties, we strengthen the health of both [humans and animals] through promotion of the healing power of the human-animal bond.”
“I am fortunate enough to have the training to help FYGVE interns realize that full potential,” said French. “My ultimate job is to teach them the ways in which they can, and will impact public health, as veterinary corps officers. Community outreach for animal related issues is an easy way to accomplish this because, typically, everyone loves puppies and kittens and not very many people know that military veterinarians exist,” French continued.
It is ideal to take this program to the elementary school classroom, as the vets on JBLM are doing. It is, however, easy to offer this information in the clinic setting as well.
French offers, “There are several dog bite prevention programs that offer information online, but RUFUS literature can be downloaded for free from www.vet.utk.edu/dogbiteprevention.”
The tenets can also be easily added to discussions with both adults and kids when they bring their animals to the clinic. Through this program, others like it, and simple conversations in the clinic, Army veterinarians support their community through increased knowledge and awareness, and through the promotion of the beneficial human-animal bond.