Deployments

Why Me? Why Can’t Someone Else Deploy?

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There have been a number of posts about deployments. We talked about how to max out your TSP, how dwell time works, gear lists, how to get clinical help while deployed, and the different types of deployments. Here is another deployment mystery revealed…

OK Specialty Leader…why do I have to deploy? What about all these other people? Can’t they go?

There are many people whose turn it is to deploy but who cannot deploy. In my experience, the reasons include:

  • They are pregnant or within 1 year post-partum, both of which made you non-deployable.
  • They have LIMDU or medical issues that make them non-deployable.
  • They are in a non-deployable position, like being a CO or working at the White House.
  • They are already with an operational unit, and the operational unit controls if/when they deploy, not the Specialty Leader. For example, I can’t deploy my ER docs who are stationed with the Marines. The Marines decide when they deploy, not me.
  • They have an upcoming resignation/retirement/PCS. You have to have at least 90 days left between the end of a deployment and your end of service or upcoming PCS.
  • They are in GME. Residents and fellows are non-deployable.
  • They have legal issues that keep them from deploying.

In addition to the factors listed above that make someone non-deployable, there are limitations on:

  • Rank – You can only go +/- one rank without a waiver. In other words, if the deployment is for a LCDR you can go down one to a LT or up one to a CDR. You can’t send a CAPT without a waiver, which might not be approved.
  • Security clearances – If people have an expired or soon-to-be expired security clearance, it can be a problem.
  • Manning in the various commands – As the Emergency Medicine Specialty Leader, which doctor I select to deploy often has more to do with the physician manning in the various ERs than whose turn it is.
  • OCONUS vs CONUS – For some deployments people from OCONUS can fill them, for others they can’t.
  • Board exam dates – As the Specialty Leader, I don’t deploy someone if it will mess up their board certification exams.
  • Commands pushing back – After I submit names for a deployment, the officer’s command can RECLAMA, which is an official non-concur with my selection. These are adjudicated by the regions (Navy Medicine East and Navy Medicine West).
  • Other things I’m undoubtedly forgetting.

For example, I just got a request for a deployment, but it overlaps all of the Emergency Medicine oral board exam dates in 2018. In addition, I was told I can’t send anyone from OCONUS. This means I can’t send any new residency graduates or anyone from OCONUS, even if they volunteer. As you can imagine, this limits who I can send and explains why someone might have to deploy for a 2nd or 3rd time when there are others who haven’t deployed.

BOTTOM LINE – When it comes to picking people for deployments, you can see there are many limitations on the process that affect who is eligible to deploy. So I guess you’ll just have to go…

Guest Post – Maximizing TSP Contributions During Deployment

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[Editor’s Note – The process of contributing to the TSP above the $18K annual limit while deployed can be confusing. Thanks to Dr. Levi Kitchen for giving us a first hand summary of how it works.]

By LCDR Levi Kitchen (Levikk81 < at > gmail.com)

Deployment offers a number of financial benefits, including tax free pay which can be directly contributed to your Thrift Savings Plan (TSP). However, this can be tricky. The following numbers are based on 2017 limits, which can be seen at this link.

Normally, the elective deferral limit is $18,000 annually. A deferral is defined as the money you elect to remove from your paycheck and contribute to the TSP. This includes either Roth or traditional TSP contributions. When deployed to a combat zone and therefore receiving combat zone tax exempt (CZTE) pay, the deferral limit for the current calendar year increases to $54,000. However, even when receiving CZTE pay, you cannot exceed $18,000 in contributions to your Roth TSP. The remaining $36,000 would have to be contributed to the traditional TSP. Also, in order to take advantage of the higher limit, the money has to come from your CZTE pay, which has to come directly from your paycheck. So, you can only take advantage of the higher deferral limits while receiving CZTE pay, not after.

Although the decision between the Roth and traditional TSP can be complicated (a matrix can be seen here), it’s probably smartest to max contributions to the Roth TSP first as, due to the CZTE, this money will never be taxed by the federal government. Once you reach a total contribution of $18,000 to the Roth TSP, DFAS will automatically stop deducting money from your paycheck. At this point, you need to change your contributions to traditional TSP in MyPay, because you’ve reached the limit of allowable Roth TSP contributions. Automatic deductions to the traditional TSP would again stop once you reach the total limit of $54,000 ($18,000 in Roth TSP and $36,000 in traditional TSP) for the calendar year, or you stop receiving CZTE pay.

As far as I know, once you stop receiving CZTE pay, your annual limit returns to $18,000 regardless of either Roth or traditional contributions. If you’ve already contributed over $18,000 while deployed, then you cannot contribute anymore to your TSP for that calendar year.

For any comments or questions, please email Levi at Levikk81 < at > gmail.com.

2017 TCCC Quick Reference Guide

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Download your copy of the Tactical Combat Casualty Care (TCCC) Quick Reference Guide:

TCCC Quick Reference Guide 2017

What you get: Abbreviated TCCC Guidelines, TCCC in Algorithm Format, Pharmacology Reference specific to TCCC, Planning Considerations, and more…

How to Get Up-To-Date on DVD if You are Deploying

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If you want to get a copy of Up-To-Date on DVD because you are deploying, you just have to send your mailing address to:

Robin.Vello <at> wolterskluwer.com

Personnel Chiefs Worry Over Deployment Pace, New Blended Retirement

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Here is a link to an article that discusses two genuine concerns, the current operational tempo and the new Blended Retirement System (BRS):

Personnel Chiefs Worry Over Deployment Pace, New Blended Retirement

Deployments and Dwell Time

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According to the policy that controls these things, dwell time is “the period of time a unit or individual is not on an operational deployment.”  This policy also states that the target deployment-to-dwell ratio is 1:2 or greater.  Here is an example to illustrate how this works:

  • You deploy for 7 months.
  • You minimum dwell time (or time at home until you get deployed again) is 14 months.

The policy spells out all sorts of ways you can request a waiver of this policy and certain other circumstances you may want to check out, but if you are in a specialty that deploys alot (like me) it is good to know that a 1:2 deployment-to-dwell ratio is the current target.

How to Get Specialty Consults/Assistance While Deployed

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It is always good to know how to get help when you are deployed.  During one of my deployments, I had a patient develop Mollaret’s meningitis, which I had never heard of, and using resources like those below I was able to get advice and provide the best care I could in a resource-limited environment.  If you are going to deploy, make sure you are aware of these services that will allow you to get some help:

HEALTH EXPERTS ON-LINE PORTAL (HELP)

This system will allow you to get specialty consults and turn the consult into a patient movement request.

(HELP PDF Information Sheet)

Background: Health Experts onLine Portal (HELP) is a web-based, HIPAA-compliant, secure, asynchronous, teleconsultation system started up by Naval Medical Center Portsmouth (NMCP) in June 2014. Naval Medical Center Portsmouth serves as the DoD’s tertiary medical care facility for Navy Medicine East Military Treatment Facilities (MTFs) in the eastern United States, Europe, Middle East, and their regionally associated Fleet and Marine assets. Many of these MTFs have limited or no access to local specialty consultation services. This vast region spans 11 time zones, making real-time synchronous teleconsultation impractical. This unique medical and geographic situation created the need for asynchronous teleconsultation capabilities. Health Experts onLine Portal was built upon the existing, tested, and proven Pacific Asynchronous TeleHealth (PATH) System in use at Tripler Army Medical Center since 2000.

System Description: HELP is a web-based, asynchronous (store-&-forward), HIPAA-compliant platform used for provider-to-provider teleconsultation, patient movement, and case management. The HELP website allows remote providers to submit patient demographics, clinical data, and supplementary multimedia as dictated by the clinical scenario. Consultations are screened by consult managers and forwarded to the appropriate subspecialist or Fleet Liaison for input. All case discussion is done on the web- based platform, with notification of new case activity via HIPAA-compliant e-mail.

Effectiveness/System Impact: HELP is based on the Pacific Asynchronous TeleHealth (PATH) system which first demonstrated improved healthcare access and quality with significant cost savings (Arch Ped Adol Med 2005 & Telemedicine and e-Health 2011). In February 2016, HELP demonstrated improved access and quality of care, while saving over $580,000 within its first year (SAGE Open Medicine 2016). Other associated benefits include HIPAA-compliance, proper documentation in the patient’s electronic health record, workload credit for specialty consultants, reduced testing, improved patient movement request coordination, and provision of continuing education to remote healthcare providers. In mid-2016, HELP brought providers and liason assets from Landstuhl Regional Medical Center and Walter Reed National Military Medical Center on board.

Patient Movement Functionality: Patient movement function was activated in February 2015 to allow outside MTFs and the Fleet improved visibility on their patients transferred to NMCP. It allows requests for information in a secure and HIPAA-compliant format, continuous situational awareness for consults, appointments, and patient arrival at NMCP. For more information on the patient movement functionality, please contact the NMCP Fleet Liaison office.

E-MAIL TELECONSULTATION SERVICE

This system is purely e-mail based, not HIPAA compliant, and cannot be turned into a patient movement request.  That said, it is still available and will allow you to get a specialty consult so I wanted to make sure the information/service was available.  The e-mail addresses and procedures to get a consult are all in this Powerpoint:

Teleconsultation Quick Reference Guide