In response to the terrorist attacks which occurred in September of 2001, the United States began combat operations in Afghanistan (Operation Enduring Freedom – OEF) and subsequently in Iraq (Operation Iraqi Freedom – OIF). Since that time approximately 1.9 million of all-volunteer troops have been deployed to these areas.
The particular operations mentioned above are considered physically and psychologically “unique” for a number of reasons. In past wars, troops were deployed once, possibly twice, whereas those fighting in OEF and OIF have seen multiple redeployments. There has been a heightened utilization of troops from the National Guard and reservists including elevated numbers of women and parents of small children. Also, due to enhanced provision of medical care at the warfront and associated military hospitals, patients are surviving injuries which in previous wars would have been fatal. This increases the need for delivery of chronic pain management, physical rehabilitation and psychological counseling by stateside medical professionals including the physician assistant (PA) and advanced registered nurse practitioner (ARNP).
There has been much publicity in recent months regarding the ability of the Veterans Administration (VA) facilities to manage the increasing numbers of troops returning from OEF and OIF as well as those from prior wars. Due to limited Congressional funds, applicants for VA healthcare benefits are now placed into “priority” categories with personal income a factor in obtaining coverage. Therefore, private practitioners must be prepared to provide treatment for veterans classified in lower categories who may be unable to obtain care in a timely manner, as well as veterans and active military personnel not in close proximity to VA or military based medical facilities.
As an emergency medicine educator, I have found that traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) are now commonly used terms by practitioners however, education in emergency and palliative treatment of disorders, unique to this special population, is not common. Practitioners should be prepared to accept the challenge, and the privilege, of determining the best course of treatment not only for the military patient’s ultimate welfare but also that of their families and their community. These patients prepared to serve us – are we prepared to serve them?
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