FORCE HEALTH PROTECTION BRANCH
Current as of 23 July 2015
OVERVIEW
• Air National Guard Disease Containment Planning Guidance
• Public Health Program Highlights
• Individual Medical Readiness (IMR)
• Reserve Health Readiness Program (RHRP)
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Air National Guard Disease
Containment Planning Guidance
AFI 10-2519 and AFMAN 10-2608
WAYNE "Top" THEURER, GS012, USAF
NGB/ANG Program Manager
Force Health Protection Branch
COM/DSN: (240) 612-9540
Wayne.c.theurer.civ@mail.mil
23 July 2015
Overview
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Directives
SAS Role
SAS PHEO duties
GMU capabilities
Wing command
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•
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AFI 10-2519 – Public Health Emergencies and Incidents of Public
Health Concern
• Published 26 June 2015
• Applicable to ANG
• ANG has it own chapter, refer to Chapter 6.
• A critical document for the roles, responsibilities, and actions
needing to be taken by USAF and ANG Installations.
AFMAN 10-2608 – Disease Containment
- Being staff now
- Release date to be determined
- Provides guidance on the development of the DCP, IEMP or other
documents.
- ANG May supplement this document with a ANG Manual or
ANGSUP
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BUSINESS SENSITIVE
State Air Surgeon’s role
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BUSINESS SENSITIVE
SAS PHEO Duties
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BUSINESS SENSITIVE
AFI 10-2519, Chapter 6, ANG
•
Guard Medical Units (GMU’s) non-collocated GMUs lack the
resident capability or personnel to prepare for and respond to a public
health emergency.
• These ANG installations must rely heavily on civilian
agencies/local authorities for support and emergency
response through use of Mutual Aid
Agreements/Memorandums of
Agreement/Memorandums of Understanding.
• ANG installations also lack the resources to support
isolation and quarantine of personnel, so GMU’s must
establish agreements w/local civilian hospitals.
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BUSINESS SENSITIVE
AFI 10-2519, Chapter 6, ANG
ANG installation commanders
• Appoint WING-PHEO-POC(or equivalent)(T-1)
• Appoint a full-time personnel (Installation XP or
equivalent) to plan for and prepare an installation level
response plan for disease outbreak (T-2)
• Ensure involvement with state and local emergency
response exercises and training,
•
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Using scenarios that consider naturally-occurring outbreaks
and contingencies that result in public health emergencies or
incidents of public health concern requiring an ANG medical
response.
AFI 90-201 Table 5.3 requires wings to exercise disease
outbreak scenarios biannually.
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Public Health Program Highlights
SMSgt Maria Tatekawa
Manager, Public Health & Prevention Branch
4E Career Field Functional Manager
COM/DSN: (240) 612-8581
maria.tatekawa@ang.af.mil
DRHA and ANAM
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Deployment Related Health Assessment (DRHA)
• AFI 48-122, Deployment Health
• ANG DRHA Guide near completion – ECD – 15 Aug 15
• Pending AFMOA final review
Automated Neuropsychological Assessment Metrics (ANAM)
• DODI/AFI being written – AF ANAM Guidance 2014 in place
• Surge Team requests must go through AFMOA
• Train-the-Trainer top proctor the course
• Active Duty 4C’s are the only AFSCs trained in the schoolhouse
• No formal guidance
• Trained proctors that attended an official course can train only
‘medical AFSCs’. Non-medical AFSCs not authorized
• Ensure one staff member has gone through the official course
until clearer guidance is developed
• Providers required training to interpret assessments
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ANG DEPLOYMENT HEALTH
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
DRHA Metric
 Compliance as of 20 Jul 15
 Air Force Goal – 100% compliance
 DRHA 1
Jan 15: 96.4%
 DRHA 2
Jan 15: 88.4%
 DRHA 3
Jan 15: 76%
 DRHA 4
Jan 15: 85.1%
 DRHA 5
Jan 15: 85.3%
Jul 15: 97.4%
Jul 15: 90.5%
Jul 15: 82.8%
Jul 15: 86.4%
Jul 15: 88.3%
Automated Neuropsychological Assessment Metric (ANAM)
 Compliance as of 20 Jul 15
 Air Force Goal – 100% compliance
 ANAM
Jan 15: 74%
Jul 15: 73%
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CRE IMMUNIZATION GROUP
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
CNGBI 3502.01, 14 May 14, National Guard Chemical, Biological,
Radiological, and Nuclear Response Enterprise Smallpox and Anthrax Vaccine
Immunization Program
ASIMS flip switched 12 Jan 15
 48 Units
 1522 personnel requiring vaccination
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44% of the CERFP enterprise are exempt
IMR rates are affected
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Smallpox
Jan 15: 34.8 %
Jul 15: 93.2% (skewed due to exemptions)

528 have exemptions: Medical Perm, Medical Temp, Assumed, Declined, Immune, Not
Required, Admin Temp, Household Contact
Anthrax
Jan 15: 13.1 %
Jul 15: 76% (skewed due to exemptions)

141 have exemptions: Admin Temp, Lab Test Pending, Medical Reactive, Medical Temp,
Medical Perm
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Air Force Safety Automated
System (AFSAS) Policy
• 23 Jan 15 – AFMOA pushed the how-to in AFSAS
requirements to report PT or fitness related incidents
that resulted in a fatality and/or those related to
cardiovascular disease etc.
• 9 Feb 15 – AFMOA released the official policy
reporting suspected medical related incidents
occurring during PT or the AF Fitness Assessment
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Immunization Policy
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Hepatitis B
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Total Force Requirement
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IMR started counting against your wing 1 April 2015
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ANG is at 98.5% AFRC 97.3% AD 99.3%
Japanese Encephalitis
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Deployment requirement on an at risk basis (seasonal)
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Gaining MAJCOM to pay NOT GMU
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ESP code is in the PACAF Reporting Instruction
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Contact your Wing FM to obtain funding. If they don’t know they need to contact
NGB/FM for guidance
MMR
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IMR requirement – Total Force Requirement
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Proof of documentation:
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2 shots of Measles and Mumps and 1 shot of Rubella
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Titer: Measles, Mumps and rubella
Smallpox
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NOT a requirement in AFCENT AOR only
STILL a requirement in PACAF AOR
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ANGIs/Processes No Longer Applicable/
Not Authorized
ANGI41-104, Fetal Protection Program
•
October 2013: Effective immediately, ANGI 40-104, Pregnancy of Air National Guard
Personnel has been rescinded
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Reference the SGPM sharepoint library for applicable AFIs
Tuberculosis Skin Testing
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2006 Self Read Policy/SG Log Letter OBE
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Self Reads no longer authorized
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Quantiferon – TB Gold (QFT-G) authorized
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HCW – high risk exposure
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Post-Deployment
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Accessions (if not done at BMT)
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If funding is needed contact NGB/SG FM - 80% obligated funds rule
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Must follow CDC TB Guidelines and AFI 48-105, July 2014
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Only trained HCW can administer, read IPPD
Malaria Prophylaxis Dispensing
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Not within the 4E community scope of practice = cease and desist!
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Training way-ahead for the 4N community/providers in the works
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Food Safety Program
• Tri-Service Food Code, AFMAN 48-147, 30 Apr 14
• Seasonal and Temporary Food Service Operations
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No denominator
Operational Risk Management Approach
Associated with air shows, festivals, wing sanctioned events (Top3, Chief’s Group, and
similar installation events
AFI 48-116, par. 2.8.20 Foods served/sold to the general public must not include home processed
•
wild game or other meats, or home-canned/home-jarred foods, or dairy products from unapproved
sources. All foods served/sold must originate from a government inspected facility (T-0).
Farmer Market OK!
• Food Vulnerability Assessment
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USAFSAM HQ Inspection every 3 years – schedule backed up
Local Food and Water Vulnerability assessment required annually
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INDIVIDUAL MEDICAL READINESS
&
RESERVE HEALTH READINESS PROGRAM
MSgt Sandra McBride
Manager, Force Health Protection Branch
4T Career Field Functional Manager
COM/DSN: (240) 612-9608
sandra.mcbride.1@ang.af.mil
Individual Medical Readiness (IMR)
UNIT TARGET:
≥ 80% = Medically Ready
65-79% (Marginal Medical Readiness)
< 65% (Substandard Medical Readiness)
Requirement:
Identifies IMR element requirements and criteria to designate members as “medically ready” to
deploy.
 IMR elements are: (1) Periodic/Preventive Health Assessment (PHA) (2) Dental Readiness
(3) Immunizations Status (4) Individual Medical Equipment (5) Medical Readiness
Laboratory Tests (6) Deployment Limiting Conditions (DLCs)
Impact to Wing: ANG Airmen will be considered not ‘medically ready’ and non-deployable
Impact to GMU:
GMU challenges: Workload and Staffing. When processing deployers that are IMR delinquent in
conjunction with additional pre-deployment medical requirements - increases GMU workload
burden. GMU’s are often delayed completing training requirements due to Wing Support services.
Gearing up for high-tempo deployments places additional workload requirements on GMU, and can
negatively affect IMR Stats as additional immunization requirements are added.
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IMR METRICS
87%
85%
Unofficial Target 85%
83.3%
83%
83.6%
83.2%
83.3%
82.5%
82.1%
81%
79%
81.7%
81.3%
Target 80%
77%
IMR 2015
IMR 2014
75%
Apr
May
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Jun
21-Jul-15
RHRP Background
OBJECTIVES
• Provide IMR, Deployment, and Occupational Health support services as of
March 2014. Currently, RHRP provides ~ 23.4K IMR services for ANG service
members annually. This does not include deployment program services. There
are 6 IMR elements for approximately 90K ANG service members. RHRP
supports approximately 4% of the total annual IMR requirements for the ANG.
• Efforts to improve/maintain 80% IMR medical readiness state with a target goal
of 85%
LIMFACS
• Historically lack of program management and oversight prior to July 2014
• Requests were approved as long as funding was available
• Historic audits for RHRP services by NGB/SG program managers--nonexistent—complaints from field or LHI prior to June 2014
• ANG IMR rate was on average low 70th percentile prior to January 2014
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CURRENT PROGRAM
OBJECTIVES
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Provide continued Group/In-Clinic Event support services to ANG units based on criteria
below:
a. GSU ≥ 50 miles from host base
b. Pre/Post Deployment Support
c. Lack of Resources (i.e. no dentists, lack of providers – based on manning document)
d. One time annual IMR Boost (Red/Yellow to Green – based on AFCHIPs)
e. Other: case by case
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Justification memorandum with corrective action plan required for item(s) c, d, and e
SERVICES
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PHA (Non-Fly only)
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Blood Draws
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Immunizations
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Audiograms
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Dental exams,
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Bitewing x-rays
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Panoramic x-rays
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Number of Group Events by Month
10
8
6
4
FY16
FY 15
FY 14
2
0
Projected Scheduled Events through 31 Jun 15
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Group Events by Service Type
3rd Quarter FY 15
Quantity
Dental Exam
Bitewing X-ray
309
Panorex
484
Immunizations = 0
340
Phlebotomy
135
PHA
480
147
Audiogram
TOTAL NUMBER OF SERVICES DELIVERED
1895
TOTAL NUMBER OF SERVICE MEMBERS SEEN
1071
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In-Clinic Events by Service Type
3rd Quarter FY 15
101
Quantity
101
Dental Exam
7
Bitewing X-ray
Panorex
904
DRHA 3
(AD Bill)
1575
DRHA 4 & 5
(AD Bill)
TOTAL NUMBER OF SERVICES DELIVERED
2688
TOTAL NUMBER OF SERVICE MEMBERS SEEN
2566
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Avoidable Costs Estimate $2,779
6 Total Events – 4 Units with Discrepancies
Group Events
$2,500
1 Apr – 30 Jun 15
$2,000
$1,500
$2,315
$1,000
$78
$360
$26
$500
$0
101 MDG
109 MDG
158 MDG
187 MDG
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Single Event
FY 15 2nd - 3rd Qtr. ANALYSIS
GMU Satisfaction Level
10
9
8
7
6
5
10
4
3
2
3
1
0
Very
Satisfied
Satisfied
Neutral
Dissatisfied
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Very
Dissatisfied
RHRP WAY AHEAD
• On-site audits to ensure contractor compliance, safety
• Quarterly QA audits: Events, service requests, invoices
• Monthly AAR review and identified problem resolution
• LHI Portal being developed for Group Events
• Better visibility group events
• Continue to manage contract and tailor services to meet ANG
requirements
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Questions
WAYNE "Top" THEURER, GS012, USAF
NGB/ANG Program Manager
Force Health Protection Branch
COM/DSN: (240) 612-9540
Wayne.c.theurer.civ@mail.mil
MSgt Sandra McBride
Manager, Force Health Protection Branch
4T Career Field Functional Manager
COM/DSN: (240) 612-9608
sandra.mcbride.1@ang.af.mil
SMSgt Maria Tatekawa
Manager, Public Health & Prevention Branch
4E Career Field Functional Manager
COM/DSN: (240) 612-8581
maria.tatekawa@ang.af.mil
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