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Needs Assessment for Injured Service Members A Consideration of Voting Accessibility for Injured OIF/OEF Service Members: Needs Assessment July 2012 Contract E4064914 2010 Voting Technology and Accessibility Research – Military Heroes Initiative CFDA #90.403 PREPARED FOR: Election Assistance Commission 1201 New York Avenue, N.W. Suite 300 Washington, D.C. 20005 PREPARED BY: Human Systems Integration Division Electronic Systems Laboratory Georgia Tech Research Institute Georgia Institute of Technology Atlanta, Georgia 30332 1 Preface This technical report documents work performed in the first contract year for a research project entitled “A Consideration of Voting Accessibility for Combat-Injured Service Members”, under contract E4064914. The work was performed by the Georgia Tech Research Institute (GTRI) and was sponsored by the Election Assistance Commission (EAC) via a grant to the Information Technology & Innovation Foundation (ITIF). Dr. Brad Fain of GTRI was the Principal Investigator for this effort. Dr. Courtney Crooks and Ms. Carrie Bell of GTRI served as Co-Investigators. Mr. Todd Williams, Ms. Elizabeth Mann, Dr. Shean Phelps, and Mr. Jerry Ray of GTRI made significant technical contributions to this work. 2 Abstract The Help America Vote Act (HAVA) disability requirements and the Military and Overseas Voting Empowerment (MOVE) Act have created a need to more closely examine voting accessibility for military voters who are injured and have physical and cognitive limitations. • Due to the nature of the military environment, particularly in hostile, deployed settings, military personnel experience a range of injuries that differs from those typically found in the general population. Thus, the range of accommodations needed for military voting also differs from those needed for the general population. o Injured military personnel are likely to receive treatment or rehabilitation in a district other than the one in which they are registered to vote; therefore, research into military voting must focus on military personnel voting by means of absentee ballots. • As of July 10, 2012, 49,008 U.S. troops have been wounded during the current conflicts in Iraq and Afghanistan. o The Improvised Explosive Device (IED) is the “weapon of choice” for insurgent forces in Iraq and Afghanistan, resulting in a shift in the types of casualties sustained by U.S. armed forces. 81% of all combat injuries related to enemy contact were due to explosions. o The most common form of injury in OIF/OEF is “polytrauma” (multiple region traumatic injury), with the average wounded service member having 4.2 different body region injuries. However, traumatic brain injury (TBI) is often referred to as the “signature injury” of OIF/OEF. Other common injuries include post-traumatic stress disorder (PTSD), hearing impairments, and visual impairments. • While the difficulties imposed by physical disabilities can be fairly straightforward, the effects of TBI and PTSD can affect functioning in cognition, sensation and perception, and emotion, which can cause difficulties in the voting process in more subtle ways. o Among other symptoms, individuals with TBI may have difficulty planning ahead and making decisions based on broad input; they may develop depression or panic disorders; and they may develop blurred vision or disconnection between visual perception and visual comprehension. o Several aspects of the voting process present accessibility challenges for wounded military personnel, including the accessibility of the physical space in which voting occurs, the design of the ballot (legibility, consistency, and the organization and presentation of information), and the technologies by which ballots are displayed to and marked by voters. • The research task documented herein was an assessment of the voting needs of injured OIF/OEF personnel. Subsequent tasks in this research effort will involve assessment of existing voting technologies and other technologies that could be incorporated into the voting process to improve accessibility, and the development of technical recommendations to improve voting accessibility to meet the specific needs of wounded military personnel. 3 Table of Contents 1 Introduction .......................................................................................................................................... 8 2 Overview of Military Voting ................................................................................................................ 10 3 Overview of the Military Medical System and the Evolution of Warfare ........................................... 11 3.1 Echelons of Care .......................................................................................................................... 12 3.1.1 Level I .................................................................................................................................. 12 3.1.2 Level II ................................................................................................................................. 13 3.1.3 Level III ................................................................................................................................ 13 3.1.4 Level IV ................................................................................................................................ 14 3.1.5 Level V ................................................................................................................................. 14 3.2 Evolution of Warfare ................................................................................................................... 14 3.2.1 Brief History of Conflict Involving the United States Armed Forces ................................... 14 3.2.2 Definition of “Regular Warfare” versus “Irregular Warfare” .............................................. 14 3.2.3 Changes in Modern Warfare and Effect on the Military ..................................................... 15 3.2.4 The Improvised Explosive Device (IED) ............................................................................... 15 4 Needs Assessment for Recently Wounded Warriors .......................................................................... 17 4.1 Epidemiology of Current Conflicts .............................................................................................. 17 4.1.1 Operation Enduring Freedom ............................................................................................. 17 4.1.2 Operation Iraqi Freedom .................................................................................................... 18 4.1.3 Operation New Dawn .......................................................................................................... 18 4.2 Literature Review ........................................................................................................................ 18 4.3 Distribution of Injuries and Analysis of Associated Barriers to Voting ....................................... 19 4.3.1 Principal Injuries by Body Region-Overview ....................................................................... 19 4.3.2 Common Injuries: OIF/OEF Service Members .................................................................... 20 4.3.3 Voting Accessibility ............................................................................................................. 25 4.3.4 Gaps in Knowledge .............................................................................................................. 26 4.4 Patient Interviews ....................................................................................................................... 27 4.4.1 Results ................................................................................................................................. 28 4.5 Summary of Lessons Learned ..................................................................................................... 32 5 Key Technologies for Accessible Voting .............................................................................................. 33 5.1 Common Approaches .................................................................................................................. 33 4 5.2 Enabling Technologies ................................................................................................................ 33 5.2.1 Screen Magnifier ................................................................................................................. 34 5.2.2 Adjustable Contrast and Brightness .................................................................................... 34 5.2.3 Speech Output .................................................................................................................... 34 5.2.4 Speech Recognition ............................................................................................................. 34 5.2.5 Touchscreens ...................................................................................................................... 34 5.2.6 Mobile Devices .................................................................................................................... 35 5.2.7 Tracking Technology ........................................................................................................... 35 6 Conclusions ......................................................................................................................................... 36 References .................................................................................................................................................
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