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Special Report  |   July 2012
Joining Forces Initiative: Steps Toward Improved Care for Military Personnel
Author Notes
  •    Michael K. Murphy, DO, FACOFP dist, FAODME, is a member of the American Osteopathic Association's Board of Trustees and is the AOA's representative on the Joining Forces Task Force. He is a decorated retired captain, Medical Corps, US Navy.
     
  • Address correspondence to Michael K. Murphy, DO, Director of Medical Education, Bluefield Regional Medical Center, 500 Cherry St, Bluefield, WV 24701-3306. E-mail: mmurphy@brmcwv.org  
Article Information
Emergency Medicine / Medical Education / Neuromusculoskeletal Disorders / Psychiatry
Special Report   |   July 2012
Joining Forces Initiative: Steps Toward Improved Care for Military Personnel
The Journal of the American Osteopathic Association, July 2012, Vol. 112, 414-415. doi:10.7556/jaoa.2012.112.7.414
The Journal of the American Osteopathic Association, July 2012, Vol. 112, 414-415. doi:10.7556/jaoa.2012.112.7.414
The Joining Forces initiative, which is jointly sponsored by the White House, the Department of Veterans Affairs (VA), and the Department of Defense (DoD), is described as “a national initiative that mobilizes all sectors of society to give service members and their families the support they earned.”1 One important component of the initiative is ensuring that medical students, physicians, and other health care providers understand that an individual's physical and mental condition may be linked to his or her military experience.2 
The American Osteopathic Association (AOA) was asked to become a partner in the Joining Forces Task Force. The members of this task force read like the Who's Who of US health care—the American Osteopathic Association, Association of American Colleges of Osteopathic Medicine, American Medical Association, and Association of American Medical Colleges, just to name a few of the more than 30 groups represented. The initial meetings were held January 9 through January 11, 2012, in Washington, DC, at the DoD's National Intrepid Center of Excellence for Psychological Health and Traumatic Brain Injury at the Walter Reed National Military Medical Center in Bethesda, Maryland, and a day of briefings by the Vice Chairmen of the Joint Chiefs of Staff, ADM James A. Winnefeld, Jr; the Surgeon General of the US Navy, VADM Matthew L. Nathan; and the Commanding Officer of the Walter Reed National Military Medical Center, RADM Alton L. Stocks. The meeting concluded with a 4-hour roundtable discussion at the White House, where the members of the task force were addressed by First Lady Michelle Obama and representatives from the DoD and the VA. 
During the past 6 months, each of the member organizations has been working diligently to promote care for our wounded warriors and their families. Such initiatives have included adding links to the Joining Forces Web site on each of the members' Web sites, as well as providing continuing medical education and seminars on the silent wounds of war, especially posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI), and on how these injuries affect returning veterans, their families, and their communities at all levels of health care. 
Community health care for veterans is especially important to primary care physicians in rural or urban areas that do not have easy access to VA facilities. More than 50% of returning veterans will seek care from their local physicians and not the VA.2 Many may not come in for PTSD or TBI but for other symptoms and complaints. They may be unaware of the effects of PTSD or TBI on their health and life upon returning or may be too ashamed to seek care initially. It then will be up to the well-trained and aware primary care physician to find the root cause of their symptoms and provide care or referral. To do this, each physician must understand that these injuries are the silent wounds of war and that they may manifest themselves in other ways. The physician must also understand the “warrior culture” that these men and women have come from and been exposed to. As we were all taught in osteopathic medical school, you cannot recognize and manage something you are not aware of. 
The AOA has fully supported the task force. For example, during a recent conference call, the AOA Executive Committee approved AOA representation and collaboration with other groups to address the initiative and provide insight into recognizing and initializing the management of PTSD and TBI. In addition, the AOA Web site Osteopathic.org features the Joining Forces logo with links to other sites promoting the initiative and with helpful tools and videos (http://www.osteopathic.org/inside-aoa/development/public-health/Pages/joining-forces-initiative.aspx). 
Among all of this activity, the 2 most exciting and distinctive initiatives are that (1) each osteopathic medical school has pledged to develop model curriculum that deals with the neurologic and psychologic injuries sustained by our returning veterans at the biomedical and the clinical stages of training11 and (2) the Educational Council on Osteopathic Principles is working to develop osteopathic manipulative treatment and osteopathic principles and practice modules for the care of returning veterans who have suffered the trauma of war, amputation, or TBI. These modules will be published for use at our osteopathic medical schools and for practicing osteopathic physicians. 
References
Joining Forces. The White House Web site. http://www.whitehouse.gov/joiningforces. Accessed June 19, 2012.
Strengthening Our Military Families: Meeting America's Commitment. Washington, DC: The White House; January 2011.
Demographics 2010: Profile of the Military Community. Washington, DC: US Department of Defense; 2010.
Veteran population. National Center for Veterans Analysis and Statistics Web site. December 2010. http://www.va.gov/vetdata/Veteran_Population.asp. Accessed June 19, 2012.
Institute of Medicine. Returning Home from Iraq and Afghanistan: Preliminary Assessment of Readjustment Needs of Veterans, Service Members and Their Families. Washington, DC: National Academies Press; 2010.
Mental health effects of serving in Afghanistan and Iraq. National Center for PTSD Web site. http://www.ptsd.va.gov/public/pages/overview-mental-health-effects.asp. Accessed June 19, 2012.
Tanielian TL, Jaycox LH, eds. Invisible Wounds of War: Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery. Santa Monica, CA: Rand Corporation; 2008.
Harrell MC, Berglass N. Losing the battle: the challenge of military suicide [policy brief]. Center for a New American Security; October 2011.
Hospitalizations among members of the active component, U.S. Armed Forces, 2009. MSMR. 2010;17(4):3-9.
Chandra A, Lara-Cinisomo S, Jaycox LHet al. Children on the homefront: the experience of children from military families. Pediatrics. 2010;125(1):16-25. [CrossRef] [PubMed]
Joining Forces national initiative. Association of American Colleges of Osteopathic Medicine Web site. http://publish.aacom.org/programs/joining-forces/Pages/default.aspx#activities. Accessed June 19, 2012.