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Illnesses and Injuries from Military Deployments Caring for Veterans : Moving Forward In Providing Quality Care August

Illnesses and Injuries from Military Deployments Caring for Veterans : Moving Forward In Providing Quality Care August 9, 2011. Victoria J. Davey, PhD, MPH, RN Chief Officer Office of Public Health VHA/VA. Outline. Veterans voices Physical, Mental, Exposure Signature health outcomes WWI

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Illnesses and Injuries from Military Deployments Caring for Veterans : Moving Forward In Providing Quality Care August

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  1. 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/VA

  2. Outline • Veterans voices • Physical, Mental, Exposure • Signature health outcomes • WWI • WWII • Korea • Vietnam • Gulf War • OIF/OEF • VA takes care of Veterans • Conclusions

  3. Definitions • Deployment ? • War? • Combat? • All of these have consequences….

  4. Veterans tell us about deployments Sleeplessness Smoke Insects Fear Pride Bullets Agony Stench Chemicals Pain Discomfort Courage Noise Damp Horror Radiation Cold Hot Sand Shame

  5. Common exposures • Burning trash • Harsh Weather Conditions • Poor Sanitary Conditions • Pesticides, herbicides • Insects • Hazardous Weapons Systems • Occupational Chemical Hazards

  6. Health Concerns of Veterans What are the risks of war? Physical environment injury noise temperature sleep deprivation diet austere conditions toxic agents infectious agents immunizations blast wave exposure

  7. Health Concerns of Veterans 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

  8. Health Concerns of Veterans What are the risks of war? Psycho-social factors Marital/family disruption Financial challenges Vocational impacts Disrupted social networks

  9. What are combat theater health risks? Psychological Risk Physical Risk Psycho-social risk

  10. International Combat Deployments • 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)

  11. International Combat Deployments • 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)

  12. World War I • Europe, Africa, Middle East, Pacific Islands, China • Trench warfare—weather, infections (1918 Flu), battlefield injuries • Mustard Gas • ‘Shell Shock’ • Staring eyes • Violent tremors • Blue, cold extremities. • Unexplained deafness, blindness, or paralysis F. 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.

  13. World War II • Europe, Pacific, Atlantic, Southeast Asia, China, Middle East, Mediterranean, Africa • Weather, battlefield injuries, prisoner of war camps, infections (“jungle rot”, malaria), concentration camp liberations • Deadliest conflict in history—50 to 70 million deaths • ‘Combat Fatigue’

  14. Korean War • Korean Peninsula • Cold • Frostbite • Limb loss • Long term sequelae ‘cold injury’ • POW mistreatment • Starvation • Korean Forces • Citizenry • DSM-1 • “Stress Response Syndrome”

  15. Frostbite 2nd degree Frostbite

  16. Vietnam • South Vietnam, North Vietnam, Cambodia, Laos • Agent Orange • Other exposures? • Napalm • Malaria, insects, insecticides • Burning trash • Poor hygiene • sanitary conditions • Stress response syndrome • Situational disorders

  17. Vietnam – Agent OrangePresumptively Service Connected Conditions • Acute and Sub-acute Peripheral Neuropathy • AL Amyloidosis • Chloracne • Chronic Lymphocytic Leukemia • Hodgkin’s Disease • Multiple Myeloma • Non-Hodgkin's Lymphoma

  18. Vietnam – Agent OrangePresumptively Service Connected Conditions • PorphyriaCutaneaTarda • Soft tissue Sarcoma • Prostate Cancer • Respiratory Track Cancer • Diabetes Mellitus-Type II • B Cell Leukemias • Ischemic Heart Disease • Parkinson’s Disease • All sequelae thereof

  19. Gulf War/Desert Storm • Iraq, Kuwait, Saudi Arabia • Exposures 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

  20. Operation Iraqi FreedomOperation Enduring FreedomOperation New Dawn • Iraq, Afghanistan • IEDs, Snipers • Exposures • Weather/cold heat • Sand • Noise • Blasts • Smoke from trash • Vehicle exhaust • Jet propellant 8 (JP8) or other fuel MSMR Vol. 12 / No. 8 – Nov. 2006 and other

  21. Psychological Trauma • 94% received small arms fire • 86 % know someone who was seriously injured or killed • 68 % saw dead or seriously injured Americans • 51 % 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

  22. Health Concerns of Combat VeteransReturning from Iraq and AfghanistanLeishmaniasis

  23. The Department of Veterans Affairs • VHA saw 6M Veterans in FY 10 • 431,543 OEF/OIF/OND (7%) • From 2001 thru 2010, VHA provided care to 683,521 separated OEF/OIF/OND • of 1.3 M who have left the military (>50%) • Characteristics • 94% were seen as outpatients • 6% as inpatients • Most visits in VISN 7, 8, 17 • 88% male; 12% female

  24. Summary • 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.

  25. Summary • 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.

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

  27. ThanksJulie ChapmanRon TeichmannVictoria CassanoTerry Walters

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