Community resource guides help Army communities

Better Soldiers through better sleep

PLUS:

APHC unveils 75th anniversary shield

U.S. Army Public Health Center Spring 2017

PEOPLE ANIMALS ENVIRONMENT

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One Health is an authorized publication for members of the U.S. Army Public Health Center. Contents of One Health are not necessarily the official views of, or endorsed by, the U.S. government or the Department of the Army. The editorial content of this publication is the responsibility of the APHC public affairs officer. Contact the staff at 5158 Blackhawk Road, Aberdeen Proving Ground, MD 21010-5403, 410-417-2937 (PAO), or e-mail usarmy.apg.medcom-aphc.mbx.pao@mail.mil.

Director:John J. Resta

Business Operations Director:Justina Allen

Public Affairs Officer:Chanel S. Weaver

Graphic Designer:Jason Embrey Visual Information Division

Photography:Graham SnodgrassVisual Information Division,unless otherwise noted

SPRING 2017 Vol. 8 No. 1

PEOPLE ANIMALS ENVIRONMENT

FOCUS A 75th anniversary message to the APHC workforce Community resource guides help community members locate needed programs and services

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UPDATES STEM program expanding to reach more military children

MISSION Fighting Army fatigue: Better Soldiers through better sleep

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PEOPLE Veteran continues tradition of selfless service12

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(COVER) APHC unveiled a new shield to celebrate its 75th Anniversary in January 2017. The shield, designed by Jerry Arnold, in the Public Health Information Directorate, Visual Information Division, features a crest that lists the abbreviations of all of the APHC’s predecessor organizations. The slogan “Healthy People, Healthy Animals, Healthy Workplaces and Healthy Communities” serves as a reminder of APHC’s vision to be the premier public health organization within the Department of Defense.

APHC Team, 2017 is an exciting year for Army public health. We are celebrating our 75th Anniversary of a continuous line of organizations that provide safe and healthy environments for our Sol-diers, Civilians, Retirees, Government-Owned Animals and Army Communities worldwide. While our public health mission has evolved over the course of 75 years, the constant con-summate professionalism of our workforce has never changed.

Throughout the year, we will be hosting several events to reflect upon our great history. Please save the date of September 21, 2017 for our formal 75th Anniversary Celebration to be held here at Aberdeen Proving Ground. Our 75th Anniversary Celebration will be a community event, and our retired colleagues are also invited to participate. I encourage you to reach out to your former co-workers and invite them to save the date to attend this his-toric event. Finally, let me also congratulate TEAM APG on celebrating 100 years as the Army’s hub of research, science and technology. We are all a part of that proud tradition and should be proud of what we do each day to promote healthy people, healthy animals, healthy com-munities and healthy workplaces.

“One Team, One Purpose...Conserving the Fighting Strength!”

John J. RestaDirector, APHC

A 75th Anniversary

Messageto the aphc

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Forty-eight Army installations across the globe have launched Community Resource Guides (CRGs) that provide a comprehensive inventory of programs and services across medical, mission and gar-rison activities. “Army commanders increasingly recognize that Soldiers, Civil-ians and Families need help identifying support services that meet their individual needs. CRGs are tools for accessing and coordinating the programs that promote health and strengthen physical, mental and spiritual resilience,” said Anna Courie, health promotion policy and evaluation project officer at the U.S. Army Public Health Center. Each guide contains a list of support programs for a particular military community organized in three ways – alphabetically, by agency and by topic to help community members easily find services they need. The CRG is also searchable with more than 7,500 resources across the Army consolidated into an interactive, web-based and mobile-friendly application. Each Army installation’s website dis-plays a CRG button to serve as a shortcut to their individual CRG. “CRGs provide ‘one-stop shopping’ for Soldiers, Civilians and Family members, as well as a comprehensive program resource for the senior commander, leaders and service providers on Army instal-lations” said Courie. “They support the Army’s goals of synchronizing programs to improve the readiness and resilience of Army communi-ty members, and they empower our Army family. With an enterprise approach to the CRG, every Soldier, Family Member, Civilian and Retiree has access to the same information, in the same way across the Army.”

Community resource guides help community members locate needed programs and services

CHANEL WEAVERU.S. ARMY PUBLIC HEALTH CENTER

In addition to helping installation community members locate services, the guides increase the awareness of installation leaders and service providers about what services their communities offer. They also provide a comprehensive referral tool for service providers who may identify additional needs when working with a Soldier or family member. Compiling the guides helps identify services that are absent in the community but might be needed. “These CRGs were developed in coordination with community health promotion councils and health promotion officers,” said Courie. “One of the goals of the Army is to synchronize and communicate programs that help Soldiers, Civilians and Families overcome, and even thrive under, the stresses of Army life.” The CRG application provides tools to inventory programs at individual installations to ensure that services are responsive to local needs. It also collects information on how the application is used by beneficiaries in order to make it more useful over time. Although the CRGs are relatively new, Courie says that more CRGs will be devel-oped as senior commanders add content managers to their staffs to provide the support in consolidating the resource data into the CRG application. “As the CRG develops analytics on user behaviors, search func-tions and cyclical patterns will be provided to the installations in order to focus community education on frequently requested pro-grams and services,” said Courie. ▲

For more information on community resource guides, visit:Army Medicine Website, https://crg.amedd.army.mil

Army officials want their Sol-diers, Civilians, Families and Retirees to be aware of a new product that allows individu-als to see what resources are available to them.

CRGs provide ‘one-stop shopping’ for Soldiers, Civilians and Family members, as well as a comprehensive program resource for the senior commander, leaders and service providers on Army installations.

—Anna Courie

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David Raugh's 13-year-old daughter aspires to work in aviation someday, possibly as an astronaut.

But being uprooted six times from schools as her family moved around the world hasn't made it easy. Pursuing academic interests can be a struggle for military children in situations like hers, her father admitted, especially in the STEM fields of science, technol-ogy, engineering and mathematics. Military family life can teach children useful skills and values like loyalty and patriotism, said Raugh, the 502nd Force Support Group commander at Fort Sam Houston. "However, we need to acknowledge that these constant moves can impact their access to some educational opportunities," he added. One way to improve STEM performance among military chil-dren is through the National Math and Science Initiative's College Readiness Program. Launched in 2007, the nonprofit program is now in more than 1,000 schools across the country. As a result, program officials say, the performance among students in those schools on advanced placement exams has exceeded 10 times the national average. Schools serving military children have also jumped on board, with more than 150 military-connected schools signed up and more funds available to expand to 200 in the next two to three years, said Matthew Randazzo, the initiative's CEO. With all of its military bases, according to Randazzo, the San Antonio area was an ideal spot to spread the program's success to more military dependents.

"All kids can be a STEM student," Randazzo said. "I can't think of a better way to enter this market than by grading these proof points with military students." Recognizing the need for more skilled professionals in STEM-related fields, the Defense Department has granted $23 million in fiscal years 2015 to 2016 to bring the program to more military-con-nected schools, he said. "They've not only committed the funds, they've also been really important advocates in connecting us in base communities," he said. In 2010, the program first came to military bases after former Army Secretary Pete Geren voiced concerns about Soldiers at Scho-field Barracks, Hawaii, being forced to send their children to private schools due to the inadequate public schools, according to program officials. More schools joined, and the rest is history. Burnie Roper, superintendent of the Lackland Independent School District, said he's interested in rolling out the program at his schools, but first he wants to get buy-in from the teachers.

SEAN KIMMONSARMY NEWS SERVICE

Maj. David Delong, an entomologist at the Army Public Health Center, allows cub scouts to touch a Madagas-car hissing cockroach doing a STEM event at APGin October. (Photo by Wilbert Moultrie, U.S. Army Public Health Center)

"It's honestly something that I want to do, but I don't make decisions in a vacuum like that," he said after the briefing. "I know that if I don't get teacher input and their support, it's not going to be successful, because they're the ones who are going to have to deliver the program." Under the initiative, teachers who instruct students from third grade to high school can take part in a Laying the Foun-dation Teacher Training Program, which coaches them on knowledge and instruction-al best practices and gives them classroom-ready materials and resources. "I think it's about preparing kids for their future and, in our future, a lot of it is STEM-based with [new] technology," Roper said. "The more STEM we can get into our schools, the better for our kids." According to Raugh, research shows that greater emphasis on STEM-related courses is helpful when students reach those middle and high school years when their enthusi-asm for science tends to dip. "This potentially allows us to stop this troubling trend," he said about the program coming to San Antonio. "This is a great opportunity, and we need to grab onto it with bulldog tenacity and not let go until this program is in place." ▲

Col.

STEM program expanding to reach more military children

MISSION

FIGHTING ARMY FATIGUE

VERONIQUE HAUSCHILD, MPHU.S. ARMY PUBLIC HEALTH CENTER

FATIGUE REFERS TO THE MENTAL AND physical deficiencies that result from lack of sleep, excessive physical, mental, and/or

emotional stress, illness, medications or a combination of these conditions. While Army programs to improve physical fitness and nutrition have been enhanced to optimize soldier capabilities, the military culture has still not given proper value to sleep. Yet poor sleep has been associated with impaired reaction time, poor judgment, accidents and low morale. In 2014 alone, fatigue was a contributing factor in 628 Army accidents and 32 deaths. We know that sleep loss results in decreased perfor-mance effectiveness and safety risks. Despite this, the military has historically accepted, if not prided itself on functioning on suboptimal amounts of sleep. Remem-ber the Army slogan, “We get more done by nine o’clock than most people do all day?” The perception that lack of sleep is the “Army way” still prevails. But some Leaders and Soldiers are starting to recognize that operationalizing warfighter management strategies to minimize fatigue is an untapped source for optimiz-ing force strength.

Figure 1. Sleep Debt Experienced by U.S. Army Soldiers

STRATEGY DESCRIPTION APPLICATION ISSUES

Reverse Physical Training (PT) Schedule

Delay start to duty day (0700 or later) and conduct PT in the afternoon instead of morning to maximize morning sleep and to synchronize with circadian rhythm

• Consider other hazards or feasibility factors such as: weather (could increase heat injury risk in warm weather), or traffic patterns (evening traffic on post may be too dangerous)

Sleep Banking Increasing hours of sleep before a known time of insufficient sleep

• Plan ahead and go to bed earlier or wake up later (e.g. use reverse PT)

• Bank up to 2 weeks (7–14 days) prior

Tactical Naps

Short sleep episodes taken when opportunities allow during tactical operations to reduce fatigue and sleep debt and improve alertness

• Essential during continuous or sustained operations to allow brain to clear protein waste, consolidate information, and regenerate

• Take the longest nap one can afford in the operational setting

NappucinoShort (~30 mins) naps immediately following a drink of coffee for a short cognitive and alertness boost

• Must be able to fall asleep readily as caffeine becomes effective at end of 30 min nap

• Gives a 3 hours boost

CaffeineWhen unable to get needed sleep, proper doses of caffeine will help improve short term alertness

• Use military caffeine gum or 200 mg of coffee (typically a cup, though will vary based on type of bean and brewing process)

• Follow proper dosing schedule (See Table 2)

Garrison Sleep-Quality Assessment

Assessment of barracks, family housing, etc. to identify and mitigate conditions not conducive to quality sleep(e.g., garbage pick-up outside barracks at 4 a.m.; routine fire alarms during sleep hours)

• Consider state regulations and local ordinances, contract agreements

• Requires coordination with installation command to ensure a finding solutions are a top priority

Tactical Sleep AreaDecisions and plans to improve the sleep environment for those on the night shift

• Separate sleep areas based on shifts to minimize disruptions

• Have a consistent sleep and wake time with a 30–60 minute transition time before bedtime to wind down

• Sleep areas should be quiet, cool, dark and safe. Enforce lights out and quiet hours. Remove, turn off or cover electronics that emit light

• For those sleeping during the day – locate the sleep zone away from noise and traffic. Shift work Soldiers need more time allotted for sleep.

Table 1. Sleep Debt Experienced by U.S. Army Soldiers

Because losing is not an option, and the cost of poor performance is high, the Army continues to find ways to improve the mental and physical capacity of its Soldiers.

So why aren’t we doing a better job of managing Soldiers’ sleep?

FATIGUE FROM LACK OF SLEEP IS CHARAC-terized by brain deactivation, especially in the parts of the brain that support judgment, think-

ing skills, and alertness. All Soldiers experience con-ditions that contribute to sleep debt (Figure 1). The average military member gets 6.2 hours of sleep per night, instead of a more optimal 7–8 hours per night. The short term consequences of sleep loss are atten-tion deficits, slowed reaction times, reduced alertness, impaired problem solving and reduced motivation. Less than 5 hours of sleep for 5 days a week can result in a 20% decrease in thinking performance. Routinely getting 5–6 hours per night of sleep is like performing with a blood alcohol level of 0.08%, which is like being drunk on duty, points out Lt. Col. Ingrid Lim, Perfor-mance Triad (P3) Sleep Lead and TRADOC Coordina-tor. Clearly, the Army is not functioning at its best when Soldiers are regularly deprived of sleep.

Inadequate sleep results in poor health, safety, and readiness. Physical abilities, a core element of force strength, can be reduced when a Soldier is tired.

But the impairment to mental sharpness, and the abil-ity to judge and evaluate information, is especially a concern. For example, sleep deprivation impacts to tedious and sedentary duties (e.g., guard duty monitor-ing equipment) are even more a concern than simple physical task duties. Of top priority, are leadership positions whose decision-making responsibilities are affected by mental fatigue. As Lim points out, this is an area in which we need more attention as unit leaders tend to get the least amount of sleep. During training

Fatigue makes fools of us all. It robs you of your skills and judgment.

—Harvey MackayThe first virtue in a soldier is endurance of fatigue; courage is only the second virtue.

—Napoleon Bonaparte

Better Soldiers through better sleep

IT’S A CULTURAL THING

IT’S ABOUT THE BRAIN

POORER PERFORMANCE AND QUALITY OF LIFE

Partial Sleep Deprivation: Insufficient sleep for several days or weeks

Total Sleep Deprivation: Being awake for 24 hours or more

Sleep Debt: Cumulative effect of

insufficient sleep+

center rotations, as one goes up in the hierarchy of leadership, the less sleep tends to be obtained.

In addition to the real-time impacts during military operations and training, there are an increasing number of sleep disorders among service members.

This is a serious public health concern. In 2014, up to 14 percent of Soldiers across the Army were diagnosed with a sleep disorder. In addition to performance decrements, accidents and low morale, Soldiers with inadequate sleep suffer from chronic diseases such as hypertension, dia-betes, depression, obesity, cancer, have higher mortality rates, lower quality of life and overall less productivity.

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Table 2. Army caffeine dosing schedule (per ATP 6-22.5)

Using Caffeine

Sustained Ops (no sleep):

200 mg @ 0000

200 mg again @ 0400 and 0800 h, if needed

Use during daytime (1200, 1600) only if needed

Night Ops with Daytime Sleep:

200 mg @ start of night shift

200 mg again 4 hours later

Last dose: at least 6 hrs away from sleep period

Restricted Sleep (6 or fewer hrs

of sleep):

200 mg upon awakening

200 mg again 4 hours later

No caffeine within 6 hours of lights out

Acknowledgments: For this article Veronique Hauschild, Injury Prevention Division-Army Public Health Center, interviewed Lt. Col. Ingrid Lim, Sleep Lead & Performance Triad TRADOC Coordinator, System for Health Directorate, Deputy Chief of Staff for Public Health, HQDA Office of the Surgeon General. Members of the 1st Armored Brigade Combat Team 1st Infantry Division assisted with a pilot P3 evaluation of sleep banking. Special appreciation to Capt. Brad Jones, Company Commander for Charlie Company, 3-66AR Battalion, Capt. Jordan Thornburg, Physician Assistant for 3-66AR Battalion, Maj. Amy Thompson, Brigade Surgeon.

How can the Army balance the need to condition Soldiers while improving sleep?

Leaders need to walk the walk the walk and sleep the sleep

TABLE 1 SUMMARIZES SEVERAL SLEEP MAN-agement strategies that can be used by the Army. One of the most recent strategies being evalu-

ated is the “reverse PT schedule.” Reverse PT includes starting the Soldier’s duty day later and having PT in the afternoon. This is partly helpful because a “0-Dark hun-dred’ wake-up call can both result in less sleep—it can affect the quality of sleep because it is not in alignment with a Soldier’s natural circadian rhythm of sleep (2300–0700 hours). Circadian rhythms can influence sleep-wake cycles, hormone release, body temperature and other important bodily functions. They have been linked to various sleep disorders, such as insomnia. They have also been associated with obesity, diabetes, depression, bipolar disorder and seasonal affective disorder.

COMMANDERS AND LEADERS ARE RESPON-sible for implementing means to improve health, wellness, performance and quality of

life of Soldiers both at home and at work. Command-ers must put as much emphasis on sleep as they give to physical fitness if we expect optimal performance. When in garrison, priority should be to ensure 8 hours on and 12 hours off so that Soldiers can be full rested in preparation for field training exercises and deploy-ments. This will improve Soldiers resilience to emo-tional injuries. Additionally, leaders must train and implement deliberate sleep management strategies so that it become routine practice, and encourage sleep banking when periods of sleep restriction are antici-pated. Though data is still limited, sleep banking ap-pears to be one example of a strategy that can be used to help our Soldiers be more receptive to new informa-tion and feedback, grasp information more quickly, and tackle tasks more efficiently. To fully optimize the potential that is lost to fatigue—Army culture must shift. “Leaders need to walk the walk and sleep the sleep, be an example for their Soldiers,” said Lim. ▲

An initial evaluation in an active unit training envi-ronment suggests that even a short-term (7–10 day) reverse PT schedule used with “sleep banking” can improve military performance. This sleeping strategy increased a unit’s average sleep from 5–6 hours to over 8 hours a night for the 10 days prior to a field train-ing exercise. The study found improved performance (measured as gunnery scores) as well as better mood, greater motivation and more energy. The leadership reported higher morale, and no accidents or injuries were reported. While Soldiers indicated a preference for conducting PT in afternoon as they were sleeping better, had improved family time, ate better breakfasts, were less irritable and less stressed overall—leaders reported difficulty with reverse PT as the rest of the workforce was on a different schedule due to meetings and work-duties.

One night when the encampment was under fire from RPGs being “lobbed over the fence,” one hit her generator. “I ran out there to do backup procedures to try to stay on line,” she said, “when a guy comes running up and attacks the fire with a fire extinguisher. We worked on it together. It was kind of funny because he was only wear-ing boxer shorts and flip flops. They told me later he was the Task Force Commander.” Smith turned 21 on the plane heading home from Somalia and she didn’t learn about the medal until five years later when stationed at Fort Stewart, Georgia.

Smith left the service but was recalled from 2002 to 2004 to support Operation Enduring Freedom. She had changed from Signal to Preventive Medicine and earned a bachelor’s degree in environmental man-agement from the University of Maryland University College, and a master’s degree in occupational safety and health from Colum-bia Southern University. The former staff sergeant became a war-rant officer in 2008. Smith said she started helping fellow vet-erans when she was a Veterans Benefits Spe-cialist with the State of Maryland but contin-ued the work after leaving their employment because she “ran into so many friends or fellow veterans who were having problems.”

continued from back cover (page 12)Veteran’s selfless service

PEOPLE

...I promised myself I would always treat people the way I would like to be treated. I deal with some characters,

but I treat everyone the same.

She said she was surprised at the amount of veterans, as well as their surviving beneficiaries, who didn’t understand their benefits, didn’t realize the programs and services they were eligible for, and had no idea how to file claims. And there weren’t a lot of places to go for help. “Technically, I started doing this in 2005,” she said, noting that she didn’t fully dedicate herself as a volunteer to helping Veterans until after her final deployment in 2012. “I wanted to continue what I started,” she said. Smith became an accredited ADSO with the Veterans of Foreign Wars and started a walk-in service at the Veterans of Foreign Wars Post 5337 in Abingdon. After two years, she extended the service to American Legions Post 135 in Perryville and American Legion Cecil Post 15 in Elkton. Now she has an online appointment service instead

of a walk-in service. Along with one-on-one counseling sessions, she hosts seminars and workshops and frequently appears as a subject matter expert at veteran-related gatherings. “It isn’t like the information is lying around. You have to look it up, then advise people of their options and follow through,” she said. “There are so many instances where I’ve helped people receive benefits or back pay that was owed to them that they didn’t even know about. But it’s not like the VA is hiding this information. You just have to know where to go or who to ask for

answers “A good outcome,” she continued, “is when the veteran feels they got their due. My goal is to get them the max they’re entitled to under the law.” Smith said she’d like to be thought of as “just a kindly vet; not a miracle worker.” “My first rule is, ‘Do no harm,” she said. “You have to take responsibility of the evidence that’s required which is different for each situation.” “I had a great teacher, who taught me ‘A veteran is a veteran,’ ” she added. “He said people make the mistake of trying to get the vet to relate to them when they should be trying to relate to the vet. I saw how he treated people and I promised myself I would always treat people the way I would like to be treated. I deal with some characters, but I treat everyone the same.” “If you had the skill sets to help someone have a better life, wouldn’t you? I just want to be thought of as someone who cares. I think that makes all the difference.” ▲

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A native of Norfolk, Virginia, Cindy Smith joined the Army at age 17 after completing accelerated course work in high school. Her career was accelerated as well. She signed up for the Signal Corps and attended basic training at Fort Dix, New Jersey in 1990. After advanced individual training at Fort Gordon, Georgia, Smith was assigned to Karlsruhe, Germany, with the 63rd Signal Battalion. Four days after she arrived in Germany, her boots were on the ground in the Saudi Arabian desert in support of Operations Desert Shield/Storm. After Desert Storm, she moved with the 63rd to Fort Gordon, Georgia briefly before heading to another hot spot – Mogadishu, Somalia where she served as a small switchboard operator stationed with a medevac unit.

Veteran continues tradition of selfless service

YVONNE JOHNSONAPG PUBLIC AFFAIRS OFFICE

She’s a Department of Defense civilian, an industrial hygien-ist with the U.S. Army Public Health Center and a devoted wife. Somehow, she also finds time to explain benefits and fil-ing procedures to veterans as an Assistant Department Ser-vice Officer, or ADSO, with the Veterans of Foreign Wars. She’s also an American veteran.

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Warrant Officer 1 Cindy Smith and her husband pose for photos in front of an Apache helicopter at the U.S. Army Aviation Museum during her Warrant Officer Section Course graduation at Fort Rucker, Alabama in 2008. (Photo courtesy Cindy Smith).

“That was even more challenging,” Smith said. “But one cool part was patching helicopter pilots to phones so they could call their wives. They would have conversations while they were in the air. It was like a morale boost.” Smith was awarded a Bronze Star Medal for her actions in Soma-lia, but she insists she “didn’t do much.”

PEOPLE