SAN FRANCISCO — Every member of the U.S. armed services undergoes a thorough medical screening before being deployed to a combat zone, Maj. Robert B. Wenzel, M.C., USA, said at the annual meeting of the American Academy of Family Physicians.
Sometimes an active-duty or reserve service member will visit his or her personal physician soon after they receive word that they're about to be deployed, requesting a letter that will excuse them from service.
“Don't waste your time writing that letter,” Dr. Wenzel said. “I'm the Department of Defense [DOD] physician that's going to make a recommendation, and your letter saying that Sgt. Smith shouldn't report means nothing to me.”
Although predeployment screenings are always conducted by DOD medical personnel, there are several ways civilian physicians can become involved, said Dr. Wenzel, commander of the U.S. Army Butzbach (Germany) Health Clinic:
▸ Objective health summary. Civilian physicians can help by providing an objective narrative summary of the patient's condition. Often DOD medical personnel have trouble locating the patient's medical records, and when that happens, the evaluation can be a slow and painful process. An objective medical summary can save the patient—and the military—a great deal of trouble.
When a service member receives a notice of deployment, he or she first reports to a mobilization center for additional training, including a briefing on the medical threats they may encounter.
They spend a full day filling out forms, getting vaccinated, and having various medical evaluations.
“All those movies that you've seen about military-medicine cattle cars, people going from one station to another and getting shots and filling out forms—it's all true,” Dr. Wenzel said. “They walk in with their records, and they go from one station to the next to the next to the next. It is designed to be a very thorough screening before we put them on a plane to Iraq or Afghanistan or one of the other sites.”
▸ Immunizations. Service members must be up to date on the standard vaccines—MMR, polio, meningococcal; those being sent to a theater of operations will receive vaccines against smallpox, hepatitis A, tetanus-diphtheria, typhoid, and influenza (if in season). Until recently an anthrax vaccine was required as well, but in 2004 a federal judge first suspended anthrax vaccinations altogether, and then allowed them with certain restrictions, including one allowing any service member to refuse the anthrax vaccine with no penalty.
Civilian physicians can help by providing patient immunization records. A patient who recently has had a tetanus shot, for example, won't need to have it repeated.
▸ Vision screening. Each service member who needs corrective lenses must have two pairs of glasses and a set of lens inserts for a chemical protective mask. If they don't already have these, they'll receive them at the mobilization site before they're sent overseas.
▸ Hearing screening. “You would be amazed at the number of people who we decide need hearing aids when they show up for their mobilization,” Dr. Wenzel said. “They've been going through life perfectly content not listening to their spouse.”
▸ Dental screening. This is the most common reason for a delay in deployment. Often a service member will be held at the mobilization site for extensive dental work before they can be deployed.
▸ HIV. Everyone receives an HIV test. Those who test positive cannot be sent overseas.
▸ Tuberculin skin test. When they test positive and have no prior history of TB, they're started on medication. Negative tests are used as a baseline. They'll receive another test following the deployment to determine whether they seroconverted while they were gone.
▸ G6PD. Everyone receives a glucose-6-phosphate dehydrogenase test, because some personnel serving in Afghanistan have contracted malaria. Standard malaria medications, such as primaquine, can cause hemolytic anemia in people who have G6PD deficiency.
▸ DNA sampling. A blood sample is collected from every service member and stored in case its DNA is needed to identify remains.
▸ Medications. Before being sent to a theater of operations, every service member must have a 180-day supply of any medications they're taking. In some cases. substitutions may be made, depending on the current DOD formulary.