Showing papers on "Afghan Campaign 2001- published in 2014"

Is deployment an "exposure" in military personnel?

Abstract: The Occupational Medicine Forum is prepared by the ACOEM Occupational and Environmental Medical Practice Committee and does not necessarily represent an official ACOEM position. The Forum is intended for health professionals and is not intended to provide medical or legal advice, including illness prevention, diagnosis or treatment, or regulatory compliance. Such advice should be obtained directly from a physician and/or attorney.

The school of hard knocks: what we've learned and relearned about transfusion in a decade of global conflict.

Abstract: The passing of a dozen years of war since the beginning of the 21st century have occasioned a good deal of introspection in UK and US military medical communities. This has been facilitated by the foresight of military medical leaders who created combat trauma registries of unprecedented scope and detail (Eastridge et al., 2006; Blackbourne et al., 2012a,b.c). Not since the Vietnam conflict have modern, Western armies been faced with such large numbers of critically injured casualties as were encountered by the United States, UK and NATO/Coalition partners in Iraq and Afghanistan. Meanwhile, the decades between Vietnam and the recent conflicts saw the development of increasingly sophisticated blood banking technologies, including the widespread adoption of modern component therapy, apheresis and transfusion transmitted disease (TTD) testing. During the same period, trauma care underwent profound evolution with the birth of trauma systems including sophisticated air and ground ambulances, trauma centres, and increased adoption of protocolised care such as the Advanced Trauma Life Support (ATLS) approach (Hoyt & Coimbra, 2007). Trauma systems brought resuscitative care to civilian trauma patients in a manner inspired by the helicopter-based combat medical evacuation system (MEDEVAC) experience in Vietnam. The trauma and transfusion medicine communities gradually moved to a crystalloidand colloid-based pre-hospital resuscitation model, with component-based blood therapy centred on red cell transfusion for treatment of haemorrhagic shock in hospital. This approach acknowledged practical considerations, like the ease of providing crystalloids and colloids in ambulances, and especially emerging safety concerns regarding transfusion related to human immunodeficiency virus (HIV) and hepatitis C virus (HCV) transmission. Furthermore, it was widely assumed that coagulation functional reserves were such that adequate platelets and coagulation factors were present in the vast majority of patients, and that plasma and platelets

Medical Activity in the Conventional Hospitalization Unit in Kabul NATO Role 3 Hospital: A 3-Month-Long Experience

Abstract: Introduction: The main goal of the North Atlantic Treaty Organization role 3 hospital located in Kabul is to provide comprehensive medical services to troops engaged in Afghanistan. Nevertheless, it also provides care for Afghan National Security Forces and for Afghan and non-Afghan civilians. Objectives: To describe the patients admitted to the conventional hospitalization unit over a 3-month period, between June 29 and October 1, 2012. Results: A total of 439 patients were admitted, for scheduled surgery, discharged from intensive care unit, or referred by emergency room and primary care physicians. Causes of hospitalization were diverse, particularly for nonscheduled admissions, with mainly war- and traffic-accident-related injuries for Afghan civilians and national security forces, and non-war- and non-traffic-accident-related trauma emergencies and gastroenteritis for non-Afghan patients. Suspected or confirmed cardiovascular diseases were a frequent cause of hospitalization and the leading c...

Care coordination: an imperative for VA obstetric care.

Abstract: As a result of the United States involvement in Operation Iraqi Freedom, Operation Enduring Freedom, and Operation New Dawn (OIF/OEF/OND), the demographics of today’s veteran has changed. One of these changes is the increased number of women veterans eligible for care from the Veterans Health Administration (VHA). Nearly 200,000 women are eligible for VHA benefits, making them the fasting growing segment of the veteran population. During the period of 2002–2012, a 7.5 times increase was seen in female veterans’ use of VHA services. Additionally, over three-fourths of those enrolled in VHA care are of childbearing age. The study conducted by Katon and colleagues identifies the prevalence of two major perinatal complications, gestational diabetes and hypertensive disorders of pregnancy (HDP) in veterans who use VHA benefits in comparison to the general population of women in the United States. Obstetric care for veterans is provided by non-VHA fee basis providers outside the VHA system. However, the investigators found that regardless of the development of these complications, a majority of the veterans in this sample returned to the VHA for postdelivery care. While this study represents one of the first analyses of reproductive outcomes in OIF/OEF/OND veterans and further identifies factors that may explain its outcomes, it also addressed another key issue: the lack of care coordination between non-VHA fee basis obstetric providers and VHA providers. Because of this disconnect, the investigators did not have access to key prenatal, intrapartum, and postpartum data that would have further informed the study outcomes. While Katon and her colleagues reference new strategies within the VHA to address this problem, a review of this effort is warranted. A relatively recent document, ‘‘VA Handbook 1330.03, Maternity Health Care and Coordination’’ provides guidance to VHA facilities on the processes for addressing the clinical needs of pregnant veterans by identifying and contracting obstetric care providers and the necessary perinatal support services. In addition, the Handbook describes the newly developed role of the VHA Maternity Care Coordinator, who is tasked to ensure care coordination and communication, to include medical record documentation, between non-VHA fee basis care providers and VHA providers. This coordination is particular important when veterans continue to utilize VHA services during their pregnancy for comorbidities. The American College of Obstetrics and Gynecology, in its document ‘‘Health Care for Women in the Military and Women Veterans,’’ also stresses the unique care needs of women veterans and the need for care coordination. Obstetrician-gynecologists should ask about women’s military service, know the veteran status of their patients, and be aware of high prevalence problems (e.g., posttraumatic stress disorder, intimate partner violence, and military sexual trauma) that can threaten the health and well-being of these women. Moreover, partnerships between academic departments of obstetrics and gynecology and local branches of the VHA are encouraged as a means of optimizing the provision of comprehensive health care to this unique group of women (2012). In 1959, these words from Abraham Lincoln’s second inaugural address became the motto of the Veterans Administration and are inscribed on metal plaques outside its headquarters in Washington, DC: ‘‘To care for him who shall have borne the battle.’’ The role of women in the United States military and the degree to which they contribution to the veteran population are very different from Lincoln’s day. Consequently, a combined effort between VHA providers and non-VHA, feebasis obstetric care providers is essential to provide quality obstetric services ‘‘to care for her who shall have borne the battle.’’

Physicians at veterans administration hospitals need to be knowledgeable about military sexual trauma in women.

Abstract: To the Editor: The important recent article by Scott et al1 examined associations between military sexual trauma (MST), childhood trauma, combat exposure, and military-related posttraumatic stress symptomatology in women who served in the recent conflicts in Iraq and Afghanistan. The authors concluded that under conditions of high combat exposure, female veterans with MST had significantly higher posttraumatic stress symptomatology compared to female veterans without MST. Multiple publications have documented that a substantial number of women who served in Iraq and Afghanistan had exposure to trauma as children and while in the military.2,3 Approximately 20%–25% of women are sexually assaulted at some point during their military service.4 MST, a form of high betrayal trauma, results in increased risk of suicidal ideation, cardiovascular disease, depression, and chronic physical problems.5,6 Today, women comprise approximately 14.5% of all active duty military and 18% of all National Guard and Reserves members.7 The number of women veterans using Veterans Affairs (VA) health care is increasing rapidly. By 2020, it is estimated that women will make up 10.7% of the US veteran population, necessitating significant changes to accommodate their unique needs.5 As members of the military return home from Iraq and Afghanistan, physicians at VA hospitals and medical centers will be interviewing and treating more women who served, including those who had combat exposure. The VA has made organizational changes to improve quality of care for women veterans over the last few years.8 It is clear, however, that VA physicians must be aware of associations between MST, childhood trauma, combat exposure, and military-related posttraumatic stress symptomatology, as discussed in the recently published article by Scott et al.1 This knowledge will improve quality of care and ensure that treatment will be appropriate and successfully goal directed.