KATHRYN J. KOTRLA, M.D. VICE DEAN TEXAS A&M HEALTH SCIENCE CENTER COLLEGE OF MEDICINE – ROUND ROCK

 OIF/OEF  PTSD  TBI  Understanding Their Experience  Linking to Available Resources

“No one comes home from war unchanged.” Iraq and Afghanistan Veterans of America, January 2008

~1.6 Million Soldiers have served 449,000 deployed > 1 tour 20% Female Soldiers As of January 23, 2006, DoD reports 505,366 OIF/OEF Veterans eligible for VA services 43% separated Active Duty troops 57% Reserve/National Guard members

Survey of 894 OIF Soldiers 95% observed dead bodies or human remains 93% were shot at; 89% were ambushed 68% saw dead or injured Americans 48% killed an enemy combatant

 NOT Knowledgeable about MH warning signs  49% Military Service Members  52% Military Spouses  Insufficient Information about Treatment options for MH  59% Military Service Members  66% Military Spouses  10% have sought treatment; STIGMA prevents MH Care

 30-40% Iraq Veterans will face depression, anxiety, or PTSD  Multiple tours and prolonged deployments increase combat stress by 50%  National Guard and Reserve at increased risk for MH issues and Suicide  Amount of TBI: Unknown  Interaction between PTSD and TBI: Unknown

 Individuals may RE-EXPERIENCE the event in a variety of ways: May experience intrusive thoughts of the event  May have distressing dreams or nightmares of the event  May feel very uncomfortable when confronted with a reminder of the event  May act or feel as if the traumatic event were recurring (“flashback”)

 Individuals may experience INCREASED AROUSAL: May be irritable and/or have angry outbursts  May experience insomnia (problems falling or staying asleep)  May be hypervigilant  May have difficulty concentrating  May startle easily and excessively

Individuals may AVOID certain triggers or reminders of the trauma and may experience EMOTIONAL NUMBING (and/or distance themselves from others). They may try to avoid: ACTIVITIES PLACES THOUGHTS PEOPLE

External force applied to the head Disruption of brain function Alteration of consciousness  incomplete memory of the event  “dazed” or confused  loss of consciousness Adapted from ACRM Special Task Force on TBI

Blast Induced Injury

MAJOR DEPRESSION JOB LOSS  ~25% jobless NARCOTIC ADDICTION MILITARY SEXUAL TRAUMA CHILD ABUSE  30% increase with each 1% deployment  Children’s academic, physiological, and psychological issues DOMESTIC VIOLENCE  Up 177% ALCOHOL ABUSE SUICIDE  18/Day  950 attempts/month INCARCERATION VIOLENCE TOWARD OTHERS DIVORCE  2/3 marriages HOMELESSNESS  ~30% SHADOW WARRIORS

Psychological Health Transportation Assistive Devices Technology Housing Career Employment Education/ Training Spirituality Military Considerations Medical Care Family Caregiver Needs SERVICE MEMBER/ VETERAN & FAMILY Benefits & Compensation

“The journey home marks the beginning of an internal war for the Marines. Give them the space they require to slowly turn the switch. The switch from violence to gentle. The switch from tension to relaxation. The switch from suspicion to trust. The switch from anger to peace. The switch from hate to love...” LT. Col. Mark Smith, WISHTV Feb 18, 2005 Down Range to Iraq and Back (Cantrell & Dean)

 Traumatic events that can be challenging to process and talk about.  Identification and closeness with their military unit and comrades who have shared similar experiences.  Regimentation in the form of highly structured and efficient routines.  Heightened sensory experiences including sights, sounds and smells.  Expanded self-importance and identity shaped by war.

Create an organized repository of all needed Federal, State, and Local services for Military Service Members, Veterans, and their Families: TexVet

 Warrior-Mentor Programs  Student Veteran Associations  Veterans County Service Officers  Bring Everyone In the Zone  Community groups (Austin, San Antonio, Houston)  Vet Centers  VHA

 Listen to what Warriors need, not what we think they need  Educate yourself about their experiences to build trust  Achilles in Viet Nam; Odysseus in America by Jonathon Shay  A Warrior’s Guide to Insanity; A Warrior’s Guide to World’s at War by SGT. (Ret) Andrew Brandi  Prove that you’ve got their backs

 Prepare for the long haul  Watch for and respect secondary traumatization  Build relationships across silos  Remember you have the expertise to shape the future for our Warriors and for Texas