Illnesses and Injuries from Military Deployments - PowerPoint Presentation

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Illnesses and Injuriesfrom Military DeploymentsCaring for Veterans: Moving Forward In Providing Quality CareAugust 9, 2011

Victoria J. Davey, PhD, MPH, RN

Chief Officer

Office of Public Health

VHA/VASlide2

Veterans voicesPhysical, Mental, ExposureSignature health outcomesWWIWWIIKoreaVietnamGulf WarOIF/OEFVA takes care of VeteransConclusionsOutlineSlide3

Deployment ?War?Combat?All of these have consequences….DefinitionsSlide4

Veterans tell us about deploymentsSleeplessnessSmokeInsectsFearPrideBulletsAgonyStenchChemicalsPain DiscomfortCourageNoise

Damp

Horror

Radiation

Cold

Hot

Sand

ShameSlide5

Burning trashHarsh Weather ConditionsPoor Sanitary ConditionsPesticides, herbicidesInsectsHazardous Weapons SystemsOccupational Chemical HazardsCommon exposuresSlide6

What are the risks of war? Physical environment injury noise temperature sleep deprivation

diet

austere

conditions

toxic

agents infectious agents

immunizations

blast

wave exposure

Health Concerns of VeteransSlide7

What are the risks of war? Psychological environment anticipation of combat combat trauma

non-combat

trauma (including

military sexual trauma)

separation

from family/home

boredom/deprivation/

hyperstimulation

Health

Concerns of VeteransSlide8

What are the risks of war? Psycho-social factors Marital/family disruption Financial challenges

Vocational

impacts

Disrupted social

networks

Health Concerns of VeteransSlide9

What are combat theater health risks?PhysicalRisk

Psycho-social

risk

Psychological

RiskSlide10

World War I (1914-18)World War II (1941-45)Korean War (1950-1953)Vietnam (1961-1975)Grenada (1983)Panama (1989)First Gulf War/Desert Storm (1990-91)International Combat DeploymentsSlide11

Somalia (1993)Bosnia (1993-95)Kosovo (1998-99)Operation Enduring Freedom/OEF (2001-present)Operation Iraqi Freedom/OIF/ (2003-2010)Operation New Dawn (2010-present)International Combat DeploymentsSlide12

Europe, Africa, Middle East, Pacific Islands, ChinaTrench warfare—weather, infections (1918 Flu), battlefield injuriesMustard Gas‘Shell Shock’Staring eyesViolent tremors Blue, cold extremities.Unexplained deafness, blindness, or paralysisF. C. Hitchcock. Stand To: A Diary of the Trenches 1915–1918. London: Hurst & Blackett, 1937; report, Heath field, England: The Naval & Military Press, Ltd., 2001.World War ISlide13

Europe, Pacific, Atlantic, Southeast Asia, China, Middle East, Mediterranean, AfricaWeather, battlefield injuries, prisoner of war camps, infections (“jungle rot”, malaria), concentration camp liberationsDeadliest conflict in history—50 to 70 million deaths‘Combat Fatigue’World War IISlide14

Korean PeninsulaColdFrostbiteLimb lossLong term sequelae ‘cold injury’POW mistreatmentStarvationKorean ForcesCitizenryDSM-1“Stress Response Syndrome”Korean WarSlide15

2nd degree FrostbiteFrostbiteSlide16

South Vietnam, North Vietnam, Cambodia, LaosAgent OrangeOther exposures?NapalmMalaria, insects, insecticidesBurning trashPoor hygienesanitary conditionsStress response syndromeSituational disordersVietnamSlide17

Acute and Sub-acute Peripheral NeuropathyAL AmyloidosisChloracneChronic Lymphocytic LeukemiaHodgkin’s DiseaseMultiple MyelomaNon-Hodgkin's LymphomaVietnam – Agent OrangePresumptively Service Connected ConditionsSlide18

Porphyria Cutanea TardaSoft tissue SarcomaProstate CancerRespiratory Track Cancer Diabetes Mellitus-Type IIB Cell LeukemiasIschemic Heart DiseaseParkinson’s DiseaseAll sequelae thereofVietnam – Agent OrangePresumptively Service Connected ConditionsSlide19

Iraq, Kuwait, Saudi ArabiaExposures of concern Protective gear/alarms (82.5%)Diesel, kerosene, other petrochems (80.6%)Oil well fire smoke (66.9%)Local food (64.5%)Insect bites (63.7%)Harsh weather (62.5%)Smoke from burning trash or feces (61.4%)Within 1 mile of missile warfare (59.9%)Repellants and pesticides (47.5%)Paint, solvents (36.5%)Schneiderman, Lincoln, Wargo

, et. al., APHA, 12-14-05

Gulf War/Desert StormSlide20

Iraq, AfghanistanIEDs, SnipersExposuresWeather/cold heatSandNoiseBlastsSmoke from trashVehicle exhaustJet propellant 8 (JP8)

or other fuel

MSMR Vol. 12 / No. 8 – Nov. 2006 and other

Operation Iraqi Freedom

Operation Enduring Freedom

Operation New DawnSlide21

94% received small arms fire86 % know someone who was seriously injured or killed68 % saw dead or seriously injured Americans51 % handled or uncovered human remains

77% shot at or directed fire at the enemy

48 % responsible for the death of an enemy combatant

28% responsible for the death of a non combatant

NEJM, July 2004

Psychological TraumaSlide22

Health Concerns of Combat Veterans Returning from Iraq and AfghanistanLeishmaniasisSlide23

VHA saw 6M Veterans in FY 10431,543 OEF/OIF/OND (7%) From 2001 thru 2010, VHA provided care to 683,521 separated OEF/OIF/ONDof 1.3 M who have left the military (>50%)Characteristics94% were seen as outpatients6% as inpatientsMost visits in VISN 7, 8, 1788% male; 12% femaleThe Department of Veterans AffairsSlide24

The U.S. military maintains national security.In war, medical departments of the military maintain the fighting force.The U.S. military constantly improves protection of the fighting force. Yet, the readiness and strength of the fighting force can never be subordinated to the potential for long term sequelae of combat.

SummarySlide25

It is the Department of Veterans Affairs’ mission to care for those who have born the burden of our wars.There are ‘signature illnesses’, but common health outcomes as well.We will continue to elucidate the health outcomes of Veterans’ military service and strive to find ways to treat them effectively.SummarySlide26

America’s Wars Total (1775 -1991)U.S. Military Service during Wartime 41,892,128Battle Deaths 651,031Other Deaths (In Theater) 308,800Other Deaths in Service (Non-Theater) 230,279Non-mortal Woundings 1,431,290Living War Veterans 11,745,600Living Veterans (Periods of War & Peace) 23,442,000Slide27

ThanksJulie ChapmanRon TeichmannVictoria CassanoTerry Walters