Thursday, April 19, 2007

Returning vets: medical care and other support

I'm attending the annual CME program of the Minnesota Academy of Family Practice, and I'm impressed. Regardless of the parlous state of American primary care in general, and family medicine in particular, this inexpensive [1] educational program just keeps getting better. The most memorable presentation thus far is unique enough, I think, to merit a post.

Colonel Basic LeBlanc, MD, of the 1BCT 34th ID "Red Bulls" (Minnesota) spoke on the medical care and global support of the returning soldier. Here are my quick notes. They are not his words, but even so I will try to separate my comments:
  • Wounded to death ratio in Vietnam: 2.6/1. In Iraq: 16/1.
    [jf: If one adjusts for this, then the 3,000 American dead today would have been about 15,000 in the 1970s. That's a significant fraction of the 50,000 US soldiers who died over 20 years in Vietnam. Is this war more routinely violent than the Vietnam war?]

  • 25-30% of returning soldiers will experience some form of emotional "disorder", usually transient.

  • Driving behavior is a significant issue for many.
    [jf: My take home -- I'll strive to be sympathetic to aggressive and seemingly irrational drivers. They may be struggling with "transitioning the combat skill". Of course I always give "bad" drivers lots of room, but it will help me be more patient.]

  • Questions to avoid asking vets: "Did you kill anyone?" [jf: apparently it does get asked], "How's it going over there?", and "When do you go back?".

  • Question for caregiver to ask: "How are you and your family doing?"
    [jf: In general the returning vets are said to welcome comments of appreciation, presumably not including any personal opinions on the incompetence of the President.]

  • Traumatic Brain Injury (TBI): LeBlanc spoke on this, but he didn't give numbers. I got the feeling this was a sensitive topic, but maybe I'm imagining things. If one speculates that there are 48,000 significantly wounded vets, and that half of them have moderate to severe TBI, that's a lot of eternal disability. That would make sensitivity understandable. Many of the care references LeBlanc provided were for Traumatic Brain Injury care.

  • The VA will likely be swamped, much vet care will have to be done in coordination with the VA by non-VA staff. If you're providing medical care, the key to coordination with the VA is to learn the "soldier's VA representative".

  • Military OneSource (1-800-342-9647) is the 24x7 coordinating site for many care related issues.
Additional resources:
  1. Post deployment health evaluation and management
  2. Craig hospital brain injury information
  3. Defense and veterans brain injury center
  4. Brain injury resource center
  5. Book: Courage after Fire
[1] OK, so it's heavily subsidized by drug companies, none of whom are doing this from the goodness of their mercantile hearts.

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