Showing papers on "Afghan Campaign 2001- published in 2015"

Ahead of the curve: Sustained innovation for future combat casualty care.

Abstract: T figure on the cover of this issue of the Journal of Trauma and Acute Care Surgery illustrates concluding casualty statistics from the wars in Afghanistan and Iraq. While various reports on morbidity and mortality among US service personnel have been provided during earlier phases of the wars, this analysis represents the first since the conclusion of combat operations in December 2014. The percentage of died of wounds, killed in action, and overall case-fatality rate are based on data from the Defense Casualty Analysis System and calculated using accepted definitions of each of these percentages. The percentage of died of wounds, killed in action, and case-fatality rate of 2.4%, 7.1%, and 9.3%, respectively, provide important information for the Department of Defense Combat Casualty Care Research Program (CCCRP) and offer compelling context for the nation and its volunteer force. Results from this analysis also show that, as a percentage of all combat-related deaths during the course of the wars, 76% were in the prehospital setting. Although substantial, this value is less than the burden of prehospital mortality in Korea (91% of combat deaths) and Vietnam (88% of combat deaths) as well as that reported by Eastridge et al. in a 2011 analysis (87%). These new findings provide evidence that efforts to research and develop knowledge and materiel solutions, combined with an appropriately postured force structure and an integrated Joint Trauma System, are having an effect on mitigating prehospital mortality. These data also show that the work is not doneVthe gaps in combat casualty care are not resolvedVand further progress must be made to improve prehospital care and alleviate the burden of survivorship (i.e., in-hospital morbidity and mortality), resulting from effective lifesaving efforts. As the analysis of concluding statistics from the recent wars continues, the Department of Defense CCCRP enters a new era, one that has it endeavoring to stay ahead of the curve and spur innovation to support future andmore complex operational scenarios. Evenwith the end of combat operations in Afghanistan, the United States maintains a significant number of troops in the country to participate in Operation Resolute Support, a North Atlantic Treaty OrganizationYled mission to provide training and support to local institutions and forces. Simultaneously, the United States and partner nations have initiated Operation Inherent Resolve in northern Iraq and Syria, while continuing small-unit surveillance and targeted operations in parts of Africa. Finally, strategic guidanceVincluding the so-called pivot or rebalance of policy toward the Asia Pacific region as well as the Army Operating Concept ‘‘Force 2025 and Beyond’’ (AOC 2025B)Vinforms the research program working to develop solutions to support combat scenarios over large-distance operations in the Pacific and in highly populated urban areas (i.e., megacities). Although the scale and conduct of these operations are likely to be different from those of the past 14 years, US personnel will continue to serve in hostile and unpredictable environments around the world. In many ways, future operational scenarios may present greater challenges to casualty care than those of the past. In this context, future combat casualty caremay be tested by longer prehospital times requiring a reappraisal of the traditional ‘‘GoldenHour.’’ During the past decade, the GoldenHour has existed as a lifesaving and resuscitation capability based on predictable and enabled levels of care. However, future scenarios, including prolonged field care (PFC) and long-distance air-, landor sea-based

Mental Health Among Military Personnel and Veterans

Abstract: This commentary describes the prevalence of mental health problems affecting military service members and veterans in North Carolina and the rest of the nation, with a special emphasis on those who served in the recent wars in Iraq and Afghanistan. Approximately 1.9 million of these veterans have become eligible for Veterans Affairs health care since 2002, and an estimated 1.16 million veterans have registered for this care.

Prevalence and correlates of cigarette smoking among operation Iraqi freedom-era and operation enduring freedom-era women from the Active Component military and Reserve/National Guard.

Abstract: Background:Tobacco use adversely affects the health and readiness of military personnel. Although rates of cigarette smoking have historically been elevated among men serving in the military, less is known about tobacco use in servicewomen.Objectives:To examine the prevalence and correlates of tobac

Review of the Fifth Annual Joint Theater Trauma System Trauma Conference.

Abstract: Military conflict requires the military health system to respond to new wounding patterns, geography, climate, and uncommon health hazards. A continuously learning health system will use multiple avenues to advance improvements. Conferences in a theater of operations are one such vehicle. This report documents specific issues of concern to military providers as discussed at a trauma conference conducted in the Afghanistan Theater of Operations in 2014.

The war on amputations: 2 fronts.

Abstract: The US War on Diabetic Limb Amputation Wound care clinicians are keenly aware that diabetes is a leading risk factor for amputations of the lower extremities. Fortunately, we are winning some battles in that regard. According to the Centers for Disease Control and Prevention, the rate of leg and foot amputations among US adults 40 years or older with diagnosed diabetes declined by 65% between 1996 and 2008. The ageYadjusted rate of nontraumatic lowerYlimb amputations was 3.9 per 1000 persons with diabetes in 2008, compared with 11.2 per 1000 in 1996. Adults 75 years or older had the highest rateV6.2 per 1000. Varying estimates indicate that 300 to 500 amputations are performed in the United States daily, and more than 147,000 surgical amputations were performed in 2010. Currently, nearly 2 million persons are believed to be living with limb loss in the United States. Authors differ in their estimates of traumatic amputees, which points to the need for a unified registry. Estimates are that about 30,000 traumatic amputations occur in this country every year. Innately traumatic amputees account for a much younger cohort than diabetic amputees. Therefore, opportunities exist now and the future for population health measures in that cohort, such as smoking cessation, blood pressure management, and body mass index control and rehabilitation. Diabetes education and cardiovascular fitness are indispensable in this group as they age because of the increasing cardiovascular demand from ambulating with an amputation and prosthesis. In juxtaposition to the civilian traumatic amputee cohort, our young men and women in uniform incur traumatic amputations as a result of war.

Human error largely to blame for MSF hospital attack, US investigators say.

Abstract: Human error, technical failures, and violations of US army rules of engagement led to the night-time air attack on the Medecins Sans Frontieres (MSF) trauma center in Kunduz, Afghanistan last October.1 The attack left 30 patients, staff, and physicians dead and 37 wounded, the army investigation concluded. Speaking from Kabul by teleconference, John F Campbell, commander of the US forces in Afghanistan, said that a report by the US military investigators found that personnel involved in the attack did not know that the compound they were targeting was the MSF trauma center but had failed to undertake the measures necessary to verify that the facility was a legitimate military target. “This was a tragic but avoidable accident caused primarily by human error,” Campbell said. The report said that Afghan troops working with US special operations forces on the ground in Kunduz province had been under heavy attack by the Taliban for five days and nights when, on 2 October, they asked for close air support in a clearing operation that included clearing the National Directorate of Security headquarters building that Afghan special operations forces believed …

Comment on "Efficacy of an Occupational Therapy Driving Intervention for Returning Combat Veterans".

Abstract: Driving is something many people take for granted. It is considered an “instrumental activity of daily living (IADL)” (Classen et al., 2014). “Driving contributes to health and quality of life by supporting independence, a sense of identity, social participation, and access to health services and the community” (American Occupational Therapy Association, 2010, p. S112). Being able to drive is based on several required skills such as “appropriate integration of visual, cognitive, perceptual, and motor skills in a dynamic environment, while maintaining control of the vehicle” (Classen et al., 2014, p. 176). These skills can very easily be compromised in “combat veterans with war related injuries” (Classen et al., 2014 p. 176). I have experienced the impact of war-related injuries on driving. A family friend was a victim of posttraumatic stress disorder. He re-experienced the trauma that he survived during random moments. This occurred while I was in the car with him. We were both safe and neither of us was hurt, but the situation could have been worse. Because of this, has restricted his driving, often staying home and excluding himself from social events. This article interests me, because an occupational therapy driving intervention may benefit him. It may help him resume driving, and maybe make less mistakes while driving, allowing him to be more socially engaged. There are more and more soldiers who come back to civilian life with issues such as posttraumatic disorder and traumatic brain injury. According to Friedman, one in eight returning soldiers suffers from posttraumatic stress disorder (Associated Press, 2004). This excludes the many other injuries that soldiers can have that can lead to mental health concerns. Given that driving is such a prevalent part of daily routine, it is likely that these injuries may influence driving and may contribute to traffic accidents and associated injuries. An occupational therapy driving intervention that is effective in addressing this problem, as supported by research, should be an option for returning soldiers with these symptoms. According to the American Occupational Therapy Association (2010), our job is to optimize independence in the ability to drive, and reduce crashes, injuries, and fatalities. As a health care practitioner, it is our job to be looking for more methods, strategies, and interventions that can help our patients. Combat veterans and wounded soldiers who are having trouble with getting back to normal civilian life are an important group. If there is a method out there that has a chance of solving any of these problems, it should be studied and implemented. As mentioned, driving is a very important part of a person’s life. The elimination of driving really affects how a person lives on a day-to-day basis. In the future of health care, I think that more and more methods will surface. They will be studied, and if they can help our patients, I think that we will be using them with our patients.