WASHINGTON, DC—Building resilience in servicemembers must start when they enter basic training and must include their families, said Chairman of the Joint Chiefs of Staff Navy Adm Michael Mullen. Mullen spoke at the annual Warrior Resilience Conference held by the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE). “We have got to start building resilience across the board in our men and women, as well as the families, from day one,” he said. “That kind of investment upfront will prevent us from the expenditure of a huge number of resources down the road.”
Mullen said that the military cannot wait until it has enough mental health professionals, otherwise it will be waiting “forever.” “So we’ve got to figure out another way to fill that capacity up,” he said. “A lot of this has to do with early intervention, with, quite frankly, building resilience from the moment a soldier, sailor, airman, or Marine or Coast Guardsman raises their hand and shows up at basic training or at boot camp. The focus of boot camp or basic [training] is oftentimes just the soldier, not the family. That’s not acceptable from my perspective.”
The military is looking to build resilience in servicemembers and their families through Total Force Fitness, a leadership-driven initiative that focuses on addressing eight areas of fitness: psychological, physical, behavioral, social, nutritional, medical, spiritual, and environmental.
The idea behind the initiative is that a holistic approach to health is needed for the military that includes both mind and body. The August 2010 Supplement to Military Medicine was devoted to the initiative and noted that the imperative for a new approach to fitness was needed because the demands on current war-fighters and their families was “overwhelming the resilience capacity of our servicemembers.”
An article in the issue highlighted that military services are experiencing rampant post-traumatic stress disorder, scores of injuries, family casualties, and increasing suicide rates and that “the framework for the current response does not match the circumstance or need.”
In 2009, at the request of Mullen, 70 experts, drawn from the operational, scientific, and educational communities, gathered at a conference at the Uniformed Services University of the Health Sciences to tackle questions such as: How do we get to total force fitness? What does total force fitness mean? What are the best strategies to move total force fitness into training?
Their research emphasized that there is currently no guidance in DoD on how to build both the physical and mental resilience of servicemembers and their families so that they can better withstand and recover from the physical and mental hardships of military service during training, deployment, war, and reintegration. In addition, they pointed out a lack of physical fitness contributes to injury, which is the number one cause of lost duty days among servicemembers. They concluded that a community approach to the management of health and fitness is needed.
The work at the 2009 conference resulted in the development of the eight domains of total force fitness which address both the mind and body for a holistic approach to health.
Nutritional fitness in the military was identified as one of the eight areas because of its impact on physical and psychological fitness. Col Christian Macedonia, MD, who serves as the medical sciences advisor to the chairman of the Joint Chiefs of Staff, said that improvements have been made at military dining facilities, but more attention to nutrition is needed.
Research shows, for example, that dietary omega-3 fatty acids have an impact on depression and psychiatric symptoms and increased intake is associated with reduced suicidal ideation. “The amount of omega-3 fatty acids in the soldier’s diet in the deployed setting is atrocious,” he said. “Particularly with post traumatic stress [disorder] and traumatic brain injury being a concern to troops, [nutrition] is an area of high concern.”
Another area in the eight domains is environmental fitness. Environmental fitness is defined as the ability to perform mission-specific duties in any environment and withstand the multiple stressors of deployment and war. Servicemembers in a deployed setting must deal with environmental stressors such as dust storms, extreme heat and cold conditions, among other things. Metrics for assessing environmental fitness are currently incompletely defined for most environments and are needed, officials said.
Moving Forward in Developing Total Force Fitness
Macedonia told conference participants that Total Force Fitness represents a change in doctrine, not a new program. “We have plenty of wonderful programs out there, we don’t need another one,” said Macedonia. “What [this] creates is a permissive environment that allows each of the services to develop their own unique service-specific fitness programs within a framework that meshes with the others.”
The Military Medicine publication on the initiative was important because it put the ideas of Total Force Fitness into writing, but it is only the beginning of the process, he said. “Now, it is this group’s turn to turn it into actionable information,” he told the conference participants. “In other words to take it from a dry medical discussion to a very practical, ‘this is how we do things.’”
Leaders, he said, set the conditions for fitness in their communities. He added that they were pleased that so many noncommissioned officers were in attendance at the Warrior Resilience Conference last month because these are the individuals leading and shaping the military.
Conference attendees participated in working groups focused on various domains of Total Force Fitness. During these sessions they were charged with generating objectives and recommendations that will be used post-conference to produce a Resiliency Training Recommendation. A formally tasked working group including service representatives will compile and draft the Resiliency Training Recommendation.
A Servicemember’s Story
“My personal resiliency was based on my desire to recover quickly and return to a normal life,” said Army Maj David Rozelle, who heads the nutrition management department and is deputy director of branch clinics at Naval Hospital Bremerton. He spoke about how resilience has played a role in his military career.
Rozelle was leading a convoy in Iraq in 2003 when he lost part of his right leg when a landmine exploded under his humvee. After completing rehabilitation, he made the decision to return to active duty and became the first amputee in the current conflict to return to the battlefield where his injury occurred. He completed a second tour in Iraq on a prosthetic leg and now encourages fellow injured servicemembers to pursue their goals.
Injured servicemembers are staying in the military, Rozelle said. As of 2011, there are 1, 179 servicemembers with major limb amputations and 313 with multiple limb loss from the current conflict. Of the 802 servicemembers with single extremity amputations, 225 have returned to duty and 45 have returned to combat. “That, ladies and gentlemen, is amazing,” he said. “I believe that there are lessons learned from this amputee population that apply to the much larger population as a whole, and those who are looking to improve resiliency.”
Rozelle said that he had great leaders who helped him during his recovery and told him that he could return to the battlefield if he recovered, despite the loss of his leg. He has not only remained active in the military, but he completed the Ironman Triathlon World Championship in Kona, HI and has used his experience to encourage other amputees accomplish their goals.
Back to March articles
The process for tracking the DoD’s most serious adverse medical events is “fragmented, impeding the Defense Health Agency’s (DHA) ability to ensure that it has received complete information,” according to a new review.
With a long history of point of care testing at both of its predecessor organizations, the Walter Reed National Military Medical Center (WRNMMC) laboratory services staff were keenly aware of the advantages of using portable testing devices to obtain rapid patient assessments.