The Road to Reintegration: Status and Continuing Support of the U.S. Air Force's Wounded, Ill, and Injured.

The U.S. Air Force asked RAND Project AIR FORCE (PAF) to help assess the well-being of its wounded members and the quality of services provided to facilitate their recovery and reintegration. RAND PAF fielded a survey in the fall of 2016 to assess wounded airmen's functioning in the domains of physical health, mental health, interpersonal relationships, unemployment, and financial status, as well as their utilization and perceptions of Air Force nonmedical programs for wounded airmen. The authors of this study invited all 713 wounded airmen enrolled in the Air Force Wounded Warrior program to complete the survey, and 270 airmen (38 percent) completed it. One-third of airmen reported difficulty obtaining care for physical or mental health conditions, and one-quarter expressed dissatisfaction with coordination of care. Similar proportions of airmen reported barriers to care for physical and mental health conditions. Difficulty scheduling appointments was the most commonly endorsed barrier for both types of conditions. Small but notable proportions of airmen reported potential social support deficits, unemployment, and financial problems. For many of the Air Force's programs for wounded airmen, over 80 percent of program users reported overall program satisfaction. The authors recommend that the Air Force consider focusing on improving care coordination, increasing health care system capacity, continuing employment assistance, and improving marketing of programs with low uptake.

Toward Resiliency in the Joint Blood Supply Chain.

The Joint military community provides a wide array of medical support services to its personnel, including the transfusion of blood and blood products. Ensuring that blood remains available and safe for transfusion requires sophisticated logistical support, especially for the military community's provision of blood to medical operations around the globe. However, that supply chain may become brittle in future potential operating environments, such as large-scale combat operations where adversaries may contest the U.S. military's freedom of movement. This study describes the elements in the military's current blood supply chain and outlines a framework for assessing its performance. Through that lens, the authors then explore an array of approaches offering promise in improving the resiliency of the blood supply chain, including alternative concepts of operation and technologies. By understanding the mechanisms that underlie blood supply chain resilience, the Joint medical community can be better positioned to tailor a robust portfolio of resiliency investments. Such a portfolio would better ensure the availability and safety of blood and blood products under a wide array of stressors and threats to the system.