CCMS Medicine Summer 2017 - 26

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So, "What to Do?" VA specialists advise getting organized
along these lines:

* Routine lab tests may show some problems, but others
may not show signs or symptoms until much later.

1. Be Informed - not only about the multitude of myriad
hazards and injuries to which military personnel are exposed,
but also where to find resource information about military
exposures, where to get email updates and reliable online resources,
for example, (a) The War-Related Illness and Injury Center
(WRIISC), a national VA post-deployment health resource, also
available at https://www.warrelatedillness.va.gov; (b) the VA's
website: www.va.gov; and especially (c) https://www.publichealth.
va.gov/exposures/providers/exposure_assessment.asp.

* "The absence of evidence is not the same as evidence
of absence!"

2. Ask about the patient's military service, training,
deployments and known exposures. Be open and empathetic.
Consider using the assessment/evaluation sheet (Figure 3) either
directly or as a self-administered pre-examination questionnaire.
3. Create a Care Plan, then Perform a Broad Health Screen.
Remember that:
* Exposures may affect any bodily system, and toxins or
organisms can enter the body in different ways.
* Different geographic areas or assignments may present
different exposure threats. (Figure 1)

* Discuss the spectrum of available VA services.
* Refer patients as needed to the appropriate specialists,
veterans service organization, VA hospital, or specialized
service: https://www.va.gov/healthbenefits/apply; as
indicated, refer to an applicable VA registry for those
exposed to Agent Orange, toxic burn pits, radiation, etc.;
or to one of their Environmental Health Clinics (nearest is
in NJ or DC); or the WRIISC listed above.
4. Finally, for those who appear to be in crisis mode,
suicidal, etc., refer to (or contact directly) the Veterans' Crisis
Hotline: Tel. 1-800-273-8255 and press 1; or email https://www.
veteranscrisisline.net
The author is a retired physician, former Director of the Chester
County Health Department, and a Vietnam Veteran himself.

Figure # 3:
MODEL MILITARY SERVICE HAZARD EXPOSURE ASSESSMENT
1. What Branch of Service ____________________________Military Specialty_____________________________________________
2. What years of service (Active)________________________(Reserves)__________________________________________________
3. Where you were trained (bases)_________________________________________________________________________________
4. Were you deployed overseas _________ How Often____________________________________________________________
Where, and Dates___________________________________________________________________________
5. Were you in combat, fire fights, ambushes, crashes, explosions___________________________________________________
6. Were you wounded, captured, interrogated, tortured_____________________________________________________________
7. Were you ever sexually assaulted, molested___________________________________________________________________
8. Physical injuries sustained_________________________________________________________________________________
9. Were you exposed to physical, chemical or other hazards_________________________________________________________
If so, route of exposure (skin, inhalation, ingestion, injection)____________________________________
What kind of hazard exposures________________________________________________________________
10. What precautions were taken (avoidance, PPE, prophylaxis, etc.)___________________________________________________
11. Did you ever observe or participate in any actions/events so horrible that you cannot now talk or think about them_____________
12. Do you have any permanent or recurrent symptoms (rage, flashbacks, sleeplessness, guilt, thoughts of self-injury_____________
13. Have you been diagnosed with PTSD___________ Use alcohol, tobacco, opiates, marijuana_____________________________
14. Are you concerned for yourself, your family or your offspring about those exposures_____________________________________
15. Are you willing to work with us &/or the VA specialists to overcome any of your problems__________________________________

26 CHESTER COUNT Y Medicine | SUMMER 2017

https://www.va.gov/healthbenefits/apply https://www.warrelatedillness.va.gov http://www.va.gov https://www.publichealth.va.gov/exposures/providers/exposure_assessment.asp https://www.publichealth.va.gov/exposures/providers/exposure_assessment.asp http://www.veteranscrisisline.net http://www.veteranscrisisline.net

Table of Contents for the Digital Edition of CCMS Medicine Summer 2017