Transcript From Combat to Classroom: Transitions of Modern Warriors

From Combat to Classroom:
Transitions of Modern Warriors
Cari Myles, MSW, LCSW
OEF/OIF Outreach Coordinator
Wm S. Middleton Memorial
Veterans’ Hospital, Madison, WI
The Global War on Terrorism
Operation Enduring Freedom (OEF)
Operation Iraqi Freedom (OIF)
Operation Enduring Freedom
The Veterans Administration OEF/OIF
Returning Combat Veteran Program
OEF/OIF Executive Director Office
Aug 2007
Federal Recovery
Coordination Program Office
July 2008
Care Management and
Social Work Service
Aug 2007
Outreach Office
Aug 2007
OEF/OIF Transition to VHA Services
OEF/OIF Executive Director Office
Care Management and Social Work Service
National
Defense Authorization Act
Senior Oversight Office Coordination
Disability Evaluation System Pilot
Yellow Ribbon Reintegration Program
Commission on the National Guard and Reserve
Support for Outside Studies
Wounded Warrior Resource Center
VHA Liaison
Outreach Office
Federal Recovery Coordination Program Office
Combat
Created
Veteran Call Center Outreach Initiative
Reserve Component Demobilization
Post Deployment Health Reassessment
Army Wounded Warrior Staff At VAMC’s
VA & National Guard Partnership & Collaboration, TAA’s
Warrior Transition Units
Disability Evaluation System Pilot
Yellow Ribbon Reintegration Program
Wounded Warrior Resource Center
Welcome Home Events
Program
OEF/OIF Care Management Program
Social Work Program
Family Hospitality Program
Caregiver Support Program
on recommendation from Presidents Commission on
Care for America’s Returning Wounded Warriors
Joint DoD/VA effort to assist severely wounded Warriors
10 Federal Recovery Coordinators at various MTF’s and VA’s
Create a Federal Individualized Recovery Plan
Life-time recovery coordinators
VA/DoD Polytrauma System of Care
Here’s some numbers…

Operation Iraqi Freedom (OIF) as of Nov 6, 2008





Operation Enduring Freedom (OEF) as of Nov 6, 2008





Total deployed:
Total Deaths: 4,193
Wounded in Action, Returned to Duty within 72 hours 17,2178
Wounded in Action, NOT Returned to Duty within 72 hours 13,556
Total deployed:
Total deaths: 622
Wounded in Action, Returned to Duty within 72 hours 911
Wounded in Action, NOT Returned to Duty within 72 hours 1, 670
Wisconsin Numbers:




Since Sept 11, 2001 over 8,000 Wisconsin National Guard and Air National Guard called to
active duty (not all to combat zone)
OEF/OIF veterans in Wisconsin
Upcoming Wisconsin National Guard will deploy over 3,500 Soldiers to OEF/OIF
FY 2008: 6,120 OEF/OIF veterans “unique users” at Madison, Milwaukee or Tomah VAMC’s
More numbers….
Veteran’s Health Administration National – (VISN 12)








Total Unique OEF/OIF vets FY 08: 260,741 (10,783)
Total VA Unique: 5,425, 126 (246,755)
% OEF/OIF workload: 4.8% (4.4%)
# of OEF/OIF Mental Health Encounters: 889,913 (39,437)
All other encounters: 2,456,099 (105,807)
Total OEF/OIF encounters: 3,346,012 (145,244)
Encounters per Unique OEF/OIF vet: 12.4 (12.9)
Women in Combat
Continuing numbers…







Approximately 1.6 million deployed, more than 1/3 more than once.
40% of troops and veterans are National Guard/Reservists
Due to equipment and immediate medical care, 90% of wounded
survive; twice as many require amputations than in previous wars
Proximity to blasts have made TBI the “signature injury” ~ 20%
Hearing damage is #1 disability
One third to one half report psychological problems
18% of veterans recently back are unemployed; of those working 25%
earn less than $21,000/year.
OEF/OIF – Common Complaints
Aches and pains

Muscular/Skeletal
Injuries
Armor is heavy 75-125 #
Common Complaints…
Aches and Pains

Hot, Dusty, Dirty,
Bugs…..
Common Complaints…
Aches and Pains

The terrain is tough…
Common Complaints…
Ringing in the ears…hearing loss

Military Training
and Combat Zone is
Noisy –
tinnitus and hearing
loss…
Common Complaints…
Can’t sleep, numb, anxious
Trauma, loss,
Readjustment….
“People say I’ve changed...I used to
be social, now I’m not; I have
anger management problems;
I don’t sleep good.”
“I’ve been home for a year now and
I’m tired of everyone being
worried about me. I get drunk
often and everyone is scared.”
“It destroyed 2 marriages; I snap at
family; it’s better for everyone
if I just stay away.”
Common Complaints…
on alert, sad, “who am I?”
The war is physically harsh,
mentally demanding and
dangerous. The enemy
wears no uniform, uses
innocent civilians, and
strikes without warning
with the intent to kill and
terrorize.
“The war…remains very
personal”
Common Complaints…
Can’t remember, get lost, headaches
Blast Injuries – TBI
Blast injuries are injuries that result from the complex pressure
wave generated by an explosion. The explosion causes
an instantaneous rise in pressure over atmospheric
pressure that creates a blast over pressurization wave.
Primary blast injury occurs from an interaction of the
over pressurization wave and the body with differences
occurring from one organ system to another. Air-filled
organs such as the ear, lung, and gastrointestinal tract
and organs surrounded by fluid-filled cavities such as
the brain and spinal are especially susceptible to
primary blast injury (Elsayed, 1997;Mayorga, 1997).
The over pressurization wave dissipates quickly,
causing the greatest risk of injury to those closest to
the explosion.
In a blast, brain injuries can also occur by other means
such as impact from blast-energized debris, the
individual being physically thrown, burns and/or
inhalation of gases and vapors. Blast injuries can be
multiple and complex and can often not be assessed in
the same manner that other brain injuries might be
examined. A better approach to take in evaluating a
brain injury caused by a blast may, therefore, be to
conduct the evaluation based on the mechanism (cause)
of the injury.
Defense and Veterans Brain Injury Center
Common Complaints..
Blast Injuries
Exposed to eight different explosions, four not "too terribly serious" but four "marked his vehicle". A couple of
events, he does not recall whether or not he was knocked unconscious. Some confusion after one of the
events; does not have anterograde memory after some of the events for unspecified amount of time.
A couple other explosions got a headache, tinnitus and "wind knocked out of him." In a couple of them, he
was wearing a helmet. Most of these events didn't worry him until he started loosing directional
sense, "I started loosing the map in my head".
The veteran was wounded in combat….his Humvee was hit by an IED and he was blown out of the vehicle.. He
was then shot at by snipers as he tried to get back to the vehicle and he returned fire
for 30 minutes. The veteran received injuries from the IED attack/ambush. He
was hospitalized initially for 6 days and then was in Germany for 6-7 days and
then was treated at the National Naval Medical Center, Bethesda for 7 months on
and off. He stated that during this attack there were 4
wounded but no killed. He stated that his job in the military as a scout team
leader was to "find IEDs before the convoy, 7 blasts to my vehicle, driving
veteran's vehicle was hit by an IED as part of the convoy scout team. He was
point. All of the attraction was to us. Four hundred plus convoys, small arms
fire all the time."
Adjusting to life after war…
The Good News is that most are doing well (80%)!!
The Transition from Battlemind to Home:
Training for war includes preparing the soldier mentally –
Self Confidence – taking calculated risks and handling challenges
Mental Toughness – overcoming setbacks and maintaining positive
thoughts during times of adversity and challenge
…..The Battlemind Walter Reed Institute of Research
Returning Home
Battlemind
Buddies vs. Withdrawal
Accountability vs.
Controlling
Targeted Aggression vs.
Inappropriate
Aggression
Tactical Awareness vs.
Hypervigiliance
Returning Home – Battlemind
Walter Reed Institute of Research
Lethally Armed vs. “Locked
and Loaded” at home
Emotional Control vs.
Anger/Detachment
Mission Operational Security
vs. Secretiveness
Battlemind – Returning Home
Walter Reed Institute of Research
Individual Responsibility vs.
Guilt
Non-defensive (combat)
driving vs. Aggressive
Driving
Discipline and Ordering vs.
Conflict
Returning to School
Trying to “melt” into student populations but with..
Exceptionally different experiences
Common physical and emotional complaints
sometimes on powerful medication
Many with problems with concentration, memory,
irritability, lack of sleep, hypervigiliance
Little to no knowledge of “Disability Resources” on
campus
How to Help?
Don’t single them out, ask if they want vet status to be known.
“Most think I lost my arm in a farming accident, I don’t bother to tell
them…”
“I don’t want to ‘get into it’ so I just act like I’ve always been this way.”
“I do OK until the discussion is about the war, then I just don’t say
anything.”
Discuss privately what you can offer them.
Like most students with disabilities but perhaps more so, as
“Warriors”, do not want special services and probably won’t
seek out.
Show interest, understand that “trust has to be earned”.
How to help…
Connect them with Veteran’s services
Connect with other Vets (if they want)
Connect with other students
Understand the richness their experiences brings to the campus
May be “heroes” but they are “ordinary”…
Ordinary American Heroes
Ordinary American Heroes
Ordinary American Heroes
Ordinary American Heroes
Ordinary American Heroes
Ordinary American Heroes….
Thank you for supporting
our country’s newest
veterans!
Cari Myles, MSW, LCSW
OEF/OIF Outreach Coordinator
Wm. S. Middleton Memorial Veteran’s
Hospital
Madison, Wisconsin 53705
(608) 256-1901 ext 11297
[email protected]