Abstract
Each year, thousands of civilian workers deploy with active duty service members to support contingency operations, often in harsh environmental conditions. Occupational health nurses aware of these challenges can implement programs to protect the health and safety of this at-risk worker population.
Global disasters or military conflicts affect the locations, numbers, and job types of civilian workers (CWs) deployed with active duty service members (SMs) to support military contingency operations. Between 3,000 and 9,000 CWs were deployed by the U.S. Department of Defense (DoD) annually from 2009 to 2016, often to austere locations without fixed medical support (Dunigan et al., 2019). Most deployments were to Afghanistan, Iraq, Kuwait, and South Korea, where CWs generally worked long hours in harsh environmental conditions including extreme temperatures or elevation changes. Meals were military food rations, and living quarters were nonstandard housing or tents. Deployments were usually 5 or 6 months, but some lasted several years. Approximately two thirds of the CWs were male with half over age 50 years. Primarily mid-level skilled professionals in civilian jobs as administrators, mechanical or electrical equipment personnel, and logisticians along with large numbers of intelligence and data processing personnel were deployed (Dunigan et al., 2019).
Continued deployment of CWs is expected and will present challenges for civilian DoD and contract occupational health nurses (OHNs) working with this population. OHNs must understand mandatory assessments, applicable policies, and system resources to appropriately direct care and educate CWs. Although some policies and systems that protect deployed SMs apply to CWs, certain gaps could increase CWs’ risks. For example, though not required for CWs, federal policies mandate SMs have annual health assessments that help evaluate deployment capability. All SMs and CWs must have health assessments within 120 days before deployment and two afterwards. OHNs are vital to ensuring these assessments are completed and chronic health conditions not overlooked. Contrary to SMs, CWs are not required to have behavioral health assessments before or after deployment (DoD, 2019). OHNs can help prepare CWs for issues common after extremely stressful situations by educating about mental health risks associated with deployment and referring to counseling as needed. OHNs are critical for ensuring SMs and CWs know and follow health protection policies for body armor, gas masks, and other personal protective equipment, along with obtaining immunizations (smallpox, anthrax, travel immunizations, etc.) and chemoprophylaxis such as antimalarial medication (DoD, 2019). OHNs have a key role in evaluating whether CWs meet established standards and are medically fit to deploy. Unlike SMs, CWs may deploy if granted reasonable accommodations under The Rehabilitation Act of 1973 (amended) for federal employees (DoD, 2010); OHNs must manage this process to prevent delays in deployment.
During predeployment, OHNs should inform CWs that any who become ill or injured while deployed receive free care at military treatment facilities (MTFs) including evacuation, which will continue at MTFs or civilian hospitals after deployment at no personal cost. Unlike SMs, workers’ compensation benefits for federal workers like CWs are administered by the Department of Labor (DoD, 2017), but OHNs are key to educating about those benefits. OHNs should also notify CWs that most registries checking long-term health effects from environmental exposures during deployment do not include CWs. OHNs can provide CWs with resources about theater-specific environmental risks, prevention strategies, and potential adverse health effects to watch for.
OHNs aware of challenges CWs experience can ensure only medically qualified individuals deploy and then help with reintegration to civilian life. CWs need access to proper Personal Protective Equipment, immunizations, and prophylactic medications prior to deployment and continued monitoring for adverse health effects after their return. OHNs, whether civilian contract or DoD employees, are critical to protecting these workers by supplying proper training and resource access.
