Supporting Our Troops:
Understanding The New Parameters of War

The Severely Injured

Marguerite David MSW, LICSW

As Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) continues into 2007, the psychosocial and physical injuries from the war continue to effect the lives of returning service members and their families. In two previous articles (Currents June ’05 and Oct. ’06), clinical information about mental health and family issues was presented. This final article of the series will focus on the impact of physical injuries upon our communities now and in the future. With more than 20,00 service members injured since 2003, physical and emotional recovery will continue for many years to come.

As with previous wars, emerging medical treatments, faster evacuation, and improved armor, i.e. Kevlar jackets, have increased the survival rate of wounded soldiers from 76% during the Viet Nam war to 90% for OIF/OEF. The survival rate increase subsequently increases the percentage of service members returning home with serious injuries. The current estimate of severely injured persons returning from combat zones is more than 15% of all those have served. During the OIF/OEF war, a new “signature weapon” has been identified. It is the improvised explosive device (IED), which causes penetrating and concussive blast injuries to arms, legs, neck and torso, as well as, burns from melting materials.

For many returning service members blast injuries have caused blindness, burns, single and multiple amputations, spinal cord injuries and traumatic brain injuries. The Department of Defense and Department of Veterans Affairs have specialized care programs for all of these injuries. The most prominent are Walter Reed Army Medical Center, Brooke Army Medical Center for amputees and burn survivors, respectively. The Veterans Administration has regional rehabilitation center for service members who are blind, spinal cord injured and traumatically brain injured. Of all these disabilities, experts have identified traumatic brain injury (TBI) as the “signature wound” of the OIF/OEF war.

The explosion from an IED or other weapons can cause the brain to move violently within the skull; either from a direct hit to the body or as a result of an unbelted passenger in a military vehicle being bounced around. Shock waves and penetrating shrapnel can also cause damage to brain tissue. Preliminary research has produced some important results. Estimates of TBI in our troops: 10% of all troops, 20% of infantry troops have sustained a TBI. Military Medical Centers have reported that 60% of all blast injures resulted in a TBI and for Marines with blast injuries, 83% had TBI. Dr. Deborah Warden, national director of the Defense and Veteran Brain Injury Center, has reported that the true proportion is probably higher, since some TBI cases are not properly diagnosed.

The traumatic brain injury statistics mentioned above include all three diagnostic categories of TBI. Mild –causes a person to be dazed and confused from a few seconds or minutes up to one hour, or results in loss of consciousness (LOC) for up to 1 hour or amnesia lasting less than 24 hours. Moderate- results in LOC for 1 hour to 24 hours or post trauma amnesia for 1-7 days. Severe- results in a prolonged state of unconsciousness or coma lasting for days or months. Persons with severe TBI require hospital care while mild to moderate injuries may or may not be treated by medical personnel. The potential of returning service members coming home with undiagnosed mild to moderate TBI makes it essential for social workers to be educated about the short and long term consequences of TBI.

The symptoms of TBI are: Mild -headache, fatigue, sleep disturbance, irritability, sensitivity to light or noise, balance problems, decreased concentration and attention span, decreased speed of thinking, memory problems, nausea, depression and anxiety and emotional mood swings: Moderate -other physical, cognitive and behavioral impairments, which last for months or are permanent. These symptoms can be related to many other causes, so it is important to take a history of loss of consciousness, exposure to multiple blast injuries, and pre-injury mental health. Post Traumatic Stress Disorder and TBI can be co morbid consequences of combat and it is important that both disabilities be considered in an assessment. Persons with combat TBI can be referred to Veterans Affairs Medical Centers for further assessment Neuropsychologists are able to confirm a diagnosis and recommend treatment options. (see Resources section)

The Department of Veterans Affairs anticipates that TBI will be a major medical and social concern and now requires all medical providers, nurses, social workers, and psychologists to complete a TBI training course in preparation for a major influx of OIF/OEF veterans who will need this expertise for proper treatment. Not all returning service members will enter the VA system; therefore, community social workers are likely to encounter veterans with TBI in a variety of settings. After TBI, personality changes and inappropriate coping can appear within the family and work place, violence, increased alcohol and drug abuse and unemployment are often the social consequences.

"These are the people who are going back into our communities all across the country, who are potentially going to struggling" said Dr. Deborah Warden, "Keep in mind, these patients, because of the nature of brain injury, can be the ones at highest risk of falling through the cracks." Social workers can support our troops by being knowledgeable about TBI and thereby; serve those who have already sacrificed for us.

References:

Resources:

Free Online CEU course on TBI-4 clock hours for social workers
On website- biaoh.org, Key words- news & education, training
Course title: “ Traumatic Brain Injury: Incidence, Prevalence and Consequences”
Brain Injury Association of America
website- biausa.org
“Emerging Health Concern, Traumatic Brain Injury”
On website -Pdhealth.mil
Department of Veterans Affairs
Website – va.gov/health
Key words – Seamless Transition, Blind Rehab, Spinal Cord Injury Rehab, Poly Trauma Centers (specially for persons with TBI, active duty and veterans)
WA state VA resources-
VA Puget Sound Health Care Systems 1-800-329-8387
Deployment Health Clinic ex .62636
Spinal Cord Injury Service ex. 62332
Poly Trauma Level II Center ex. 63109
Neuropsychologists
Website: div40.org

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