Transcript Traumatic Brain Injury Post Traumatic Stress Syndrome

Joining Forces Initiative
Traumatic Brain Injury
Post Traumatic Stress Syndrome
Michael K Murphy, DO
FACOFP, dist, FAODME
DME, Bluefield Regional Medical Center
CAPT MC USN (ret)
Joining Forces
Joining Forces
• “For this newest generation of
American veterans and their families,
PTSD, TBI, and post-combat
depression have become the
signature wounds of our latest
conflicts.”
• –First Lady Michelle Obama
Joining Forces
• “We’ve got to make sure that no matter where
they seek help, our veterans and military
families get care that’s worthy of their service.
They deserve doctors who understand military
culture and the challenges that come along with
a life in our Armed Forces. They deserve nurses,
social workers, and counselors who have
access to the most cutting-edge research and
techniques for diagnosis and care. And they
deserve a health care system that fully
understands these issues and is focused on
solving them.” –First Lady Michelle Obama
Joining Forces
“We know that one of the biggest challenges our
troops and their families will face is mental health
challenges – the unseen wounds of war. These
challenges put a strain on marriages, family
relationships, even friendships. Spouses can feel
isolated and lonely. Kids might act out. It used to be
that no one talked about these issues. But that’s
why we’re here today – because each one of us is in
a position to help.”
–Brad Cooper, Executive Director of Joining Forces
Joining Forces
• Accreditation Council for Graduate Medical
Education (ACGME)
• American Association of Colleges of Osteopathic
Medicine (AACOM)
• Association of Academic Health Centers
• Association of American Medical Colleges
• Council on Social Work Education
• National Board for Certified Counselors
• National Board of Medical Examiners
• Physician Assistant Education Association
Joining Forces
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American Academy of Family Physicians
American Academy of Nurse Practitioners
American Academy of Pediatrics
American Academy of Physician Assistants
American College of Physicians
American Medical Association AMA
American Nurses Association
American Osteopathic Association (AOA)
American Psychiatric Association
Medscape
Joining Forces
• American Academy of Physical Medicine and
Rehabilitation
• American Academy of Neurology
• American Academy of Pain Medicine
• American College of Emergency Physicians
• American College of Surgeons
• American Congress of Obstetricians and
Gynecologists
• Citizen Soldier Support Program
• National Association of Social Workers
Joining Forces
• American Association of Oral and Maxillofacial
Surgeons
• American Association for Marriage and Family
Therapy
• American Dental Association
• American Physical Therapy Association
• American Psychiatric Institute for Research &
Education
• American Psychological Association
• National Area Health Education Center Organization
• National Association of Community Health Centers
TBI and PTSD
Objectives
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Understand the Joining Forces initiative
– Be familiar with the resources available
Be familiar with the
– definition for TBI
– Symptoms of TBI
– Treatment of TBI
Be familiar with the
– definition for PTSD
– Symptoms of PTSD
– Treatment of PTSD
TBI and PTSD
To understand the injured warrior you
must understand the warrior culture
Special Assistant to the Chairman
of the Joint Chiefs of Staff
TBI and PTSD
Warrior Ethos
• I will always place the mission first.
• I will never accept defeat.
• I will never quit.
• I will never leave a fallen comrade.
TBI and PTSD
Factoids
• 2.0 million men and women have served in the
two war zones
• 10-17% have experienced situations or injuries
that could result in TBI/PTSD
• 50% are not reported
• >50% are treated in their communities
• TBI and PTSD are considered the silent injuries
of war
TBI and PTSD
Factoids
• Since Sept.11, 2001, more than 2 million U.S. troops have been
deployed to Iraq and Afghanistan. About 40% of current
military service members have been deployed more than once.
• There are 1.4 million active duty service members—14% of
whom are women—and 1.1 million Guard and Reserve
members.
– There are 2.0 million spouses and children/dependents of
active duty service members.
– 44% of active duty service members have children—76% of
these children are age 11 and younger.
– Only 37% of families live on military installations; the
remaining 63% live in over 4,000 communities nationwide.
Strengthening Our Military Families: Meeting America’s Commitment January 2011
Demographics 2010: Profile of the Military Community
TBI and PTSD
Factoids
• With the end of the war in Iraq and the drawdown in
Afghanistan, over 1 million service members are
projected to leave the military between 2011 and
2016.
• There are an estimated 22.2 million Veterans in the
U.S.—8% of whom are women.
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National Center for Veterans Analysis and Statistics, Veteran Population Projection Model
(VetPop) 2007
TBI and PTSD
Factoids
• In the current conflicts, the military has experienced multiple
re-deployments; short dwell time between deployments;
greater dependence on the National Guard and reserve
components; deployment of high numbers of women and
parents of young children; and a higher number of service
members who survive serious injuries that in previous wars
would have been fatal.[i]
• The majority of returning service members and their families
are resilient to the stresses of war and successfully re-adjust to
life after deployment.
[i] Returning Home from Iraq and Afghanistan: preliminary assessment of readjustment
needs of veterans, service members and their families. 2010. Institute of Medicine
TBI and PTSD
Factoids
• About one in three U.S. service members returning from Iraq or
Afghanistan experiences signs of combat stress, depression,
post traumatic stress disorder (PTSD) or symptoms of a
traumatic brain injury (TBI).
• Only 53% of returning troops who screened positive for PTSD
or major depression sought help from a provider for these
conditions in the preceding year.
• Of those who had PTSD or depression and sought treatment,
only slightly over half received adequate treatment.
Tanielian, T. L., RAND Corporation & Center for Military Health Policy Research.
(2008). Invisible wounds of war: Psychological and cognitive injuries, their
consequences, and services to assist recovery.
TBI and PTSD
Factoids
• Only 57% of those with a probable TBI had been evaluated by a
physician for a brain injury in the preceding year.
• Although 53% of recent Iraq and Afghanistan Veterans receive
their health care through the VA, many Veterans and their
families will seek care in community settings from primary care
and community mental health clinicians.
National Center for PTSD. Mental health effects of serving in Afghanistan and
Iraq. http://www.ptsd.va.gov/public/pages/overview-mental-health-effects.asp
TBI and PTSD
Factoids
• Of recent Operation Enduring
Freedom/Operation Iraqi Freedom (OEF/OIF)
Veterans who used VA care, 48% were
diagnosed with a mental health problem.
• In the five years from 2005 to 2010, on
average, one service member committed
suicide every 36 hours.
Losing the Battle: the challenge of military suicide. Center for a New American Security.
October 2011
TBI and PTSD
Factoids
• U.S. Army suicides reached an all-time high in July 2011 with
the deaths of 33 active and reserve component service
members.
• Mental and substance use disorders caused more
hospitalizations among U.S. troops in 2009 than any other
cause.
• Children of deployed military personnel have more school,
family and peer-related emotional difficulties, compared with
national samples.
Zoroya, G. (2010, May 14). Mental health hospitalizations up for troops. USA Today. (Original
source: Pentagon’s Medical Surveillance Month Report.)
Chandra, A., Lara-Cinisomo, S., Jaycox, L. H., et al. (2010). Children on the homefront: The
experience of children from military families. Pediatrics, 125, 16–25.
TBI and PTSD
Factoids
• 2.3 million men and women have served in the
two war zones
• 10-17% have experienced situations or injuries
that could result in TBI/PTSD
• 50% are not reported
• >50% are treated in their communities
• TBI and PTSD are considered the silent injuries
of war
TBI and PTSD
TBI and PTSD
Military Health History
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Tell me about your military experience.
When and where do or did you serve?
What do or did you do while in the service?
How has military service affected you?
TBI and PTSD
Military Health History POSITIVE
• Did you see combat, enemy fire or casualties?
• Were you wounded, injured or hospitalized?
• Did you ever become ill while you were in the
service?
• Were you a prisoner of war?
TBI and PTSD
There is still a stigma associated with TBI
and PTSD.
Many veterans and active duty attempt to
work through this or to seek care outside
the system to avoid this.
Lt Cmdr Richard Jadick, DO, MC, USN
Joining Forces Initiative
Traumatic Brain Injury
Post Traumatic Stress Syndrome
Michael K Murphy, DO
FACOFP, dist, FAODME
DME, Bluefield Regional Medical Center
CAPT MC USN (ret)