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                                                                                                     References 

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                                                                                                     References 

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American Psychiatric Association. (2013). Postraumatic Stress Disorder.  Retrieved from http://www.dsm5.org/Documents/PTSD%20Fact%20Sheet.pdf

Bagalman, E. (2011).  Traumatic brain injury among veterans. Congressional Research Service, 7, 1-23.

Closed Head Injury. (n.d.) Retrieved from http://www.sw.org/HealthLibrary?page=Traumatic%20Brain%20Injury`

Cook, P. (2016) NFL, Military Tackle Traumatic Brain Injuries. Bloomberg News. Retrieved from http://www.bloomberg.com/news/videos/b/ebfbe7da-66b0-44a9-98eb-116b3b9a79c8

Defense and Veterans Brain Injury. (2015). Department of Defense Worldwide Numbers for TBI, Retrieved from http://dvbic.dcoe.mil

Ludwinski, P. (2014, June 7). Atlanta Veterans Administration Medical Center Review. Retrieved from https://www.youtube.com/watch?v=8zguivDfFSg

Make the Connection. (2013, March 27). Taking care of yourself with VA support. Retrieved from https://www.youtube.com/watch?v=H1GwKa72N0A

National Institute of Health. (2015). National Institute of neurological disorders and stroke: traumatic brain injury. Retrieved from http://www.ninds.nih.gov/

Silver, D. and Arciniegas, D. (2006). Traumatic brain injury: a neuropsychiatric perspective. University of Colorado Denver. Retrieved from http://www.ucdenver.edu

Sites, K. (2012, June 20). Three critically wounded-combat aid station clip2.mov. Retrieved from https://www.youtube.com/watch?v=pX5wWIywFAU

The Brain Injury Recovery Network. (n.d.) Retrieved from http://www.tbirecovery.org/

Traumatic Brain Injury. (n.d.) Retrieved from http://www.sw.org/HealthLibrary?page=Traumatic%20Brain%20Injury

Wood, D. (2013). Iraq, afghanistan war veterans struggle with combat trauma. World Post, 8(21), 5-6.

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Atlanta  Veterans Administration Medical Center REVIEW

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After having eye,ear,nasal,and dental issues,I commend The Atlanta Veteran's Hospital as being "A-ok!" Since relocating to GA in 1992,I've been attended to very well and have nothing but positive comments about the blessed assistance I've received.

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The quality of care for the service member vs. the civilian should NOT be any different.  The doctors, nurses, and ancillary staff within the VA health care systems often work at private hospitals too.  The government funds the VA health care systems where as  the private hospital may be non-for-profit (private insurance) or funded through medicare/medicaid.

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Types of alternative medicine therapy described by the The Brain Injury Recovery Network can include:
Exercise (ex./ Water Aerobics)

Religious and spiritual advisement

Massage, acupuncture and cranio-sacral therapy

Herbal Supplements (ex./ Efa Gold Neuromins Microalgae Oil- for mental and visual wellness)

Lymph drainage and hyper-baric oxygen therapy

retrieved from https://www.tbirecovery.org

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Treatment for the TBI may need to be managed on a long-term or sub-acute plan.

The VA health care systems offers Polytrauma Rehabilitation Facilities in Richmond, VA, Palo Alto, CA, San Antonio, TX,  Tampa, FL, and Minneapolis, MN.  Beyond these five facilities the VA health care systems offers network, support and point of contact sites throughout the U.S.

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Mental Health Treatment and Need for Support

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Mental Health Treatment and Need for Support

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Keith was injured off base when he was caught in a fight and knocked unconscious. He returned to his duties, but had trouble staying focused and felt depressed. His supervisor recommended he get checked out, and he was hospitalized for a brain injury.

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The recovery phase from a TBI should focus and promote the veteran's ability to identify when support is needed.

Support for the TBI service member should include family/friends.  Healing/recovery can not be done alone, having positive reinforcement and encouragement is number #1 in promoting good mental-health.

U.S. Department of Veterans Affairs (2015) states, mental health treatment is needed when the veteran:

Feels excessively tired all of the time

Feels sad and anxious

Gets frustrated or overwhelmed easily

Sleeping less than normal

Feels irritated or angered all the time

Does things without stopping or thinking

Has trouble focusing, concentrating or remembering tasks

Taking more of a prescription or over-the-counter medication

Using illegal drugs or drinking more alcohol

Smoking or using tobacco more frequently

Not feeling like yourself

Moderate to severe TBIs have mental health-related effects that may last longer or remain permanently.  However medications are available that decrease the side effects help reduce signs and symptoms.

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Service members recovering from TBIs need:  adequate rest, establishment of a regular/daily routine, the ability to recognize triggers that can worsen symptoms, writing things down via electronic reminders if there is trouble with remembering, taking up a hobby or recreational activity and use of family and friends to hlep prevent isolation ( U.S. Department of Veterans Affairs, 2015).

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Stabilization of the TBI service member 

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Stabilization of the TBI service member 

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Three Critically Wounded- Combat Aid Station Clip 2.mov

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WARNING: SOME GRAPHIC MEDICAL PROCEDURES DEPICTED U.S. Combat Medics mostly from 3.2 Cavalry and newly deployed to Afghanistan, surround the gurneys, five or six per victim, as if they were hungry animals at a feeding trough.

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Veteran Healthcare vs. Civilian Healthcare

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Veteran Healthcare vs. Civilian Healthcare

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Government funded VA Medical Centers provide our service members with the necessary treatment for a TBI if not active duty.  If the severity of the TBI is life threatening while in combat, the service member is medi-evacuated to Landstuhl Regional Medical Center in Germany then furthur transported within 72 hours to inpatient TBI centers such as Walter Reed National Military Medical Center or Brooke Army Medical Center for stabilization and care in the U.S. (DoD, 2015).
Civilian treatment and care is similar to military healthcare, but the transport of the TBI patient to a trauma center can be achieved quicker because  the event has occurred in the U.S.  Successful treatment of the TBI is only achieved if the injury is assessed and diagnosed quickly.

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The veterans of OEF and OIF often incurred injuries from more than one mechanism, the Department of Defense and Veterans Brain Injury Center (2016) describes 4 types of blasts:
Primary Blast: Atmospheric over-pressure followed by under pressure or vacuum.
Secondary Blast: Shrapnel that hits the service member from a blast.
Tertiary Blast: Service member thrown related to the force of the blast.
Quaternary Blast:  Injuries from the blast such as burns, fractures and  nerve damage.

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The veteran may have mental health-related effects from the TBI, that if not treated can lead to depression, anxiety, drug/alcohol abuse, feelings of despair and suicidal ideation (Waisman et al. 2010).

The service member may develop symptoms of post-traumatic stress disorder (PTSD).

PTSD is defined by the American Psychiatric Association (2013), as a traumatic event that occurred as a result of an event that threatened lives or caused a death, incurred serious injury or sexual violation of someone.  The symptoms can include reoccurring nightmares, distressing thoughts, avoidance of talking about or being reminded of the event, negative alterations in  thoughts or mood, symptoms of increased irritability/anger, difficulty concentrating, and hypervigilance.

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The veterans of OEF and OIF have a higher incidence of TBI and the plan of care is not limited to neurological management, but the affects of PTSD, amputations, and/or burns/fractures.

OEF and OIF service members have more diverse injuries because of the advancement in artillery.  Even with improvements in protective gear (i.e./ Keflar) the artillery used causes secondary injuries that leads to complex long-term care.
Statistics retrieved from the Department of Defense (2015)

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The care plan should focus on the long-term effects and should foster mental-health, rehabilitation and alternative medical modalities.

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Service members may feel afraid to seek treatment because of the stigma connected with demotion of rank or fear of abandoning there troop.

The Department of Defense in 2011, "instituted that every service member involved in a blast event (within 50 meters), needs to be evaluated and removed from combat/training for 24 hours."

This policy gives service members reassurance that the government supports treatment for TBIs and no retaliation will occur from receiving treatment.

Removing the reluctance of the service member to receive treatment can help decrease the long-term effects of disturbances that can occur.

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Understanding the Veteran Culture vs. Civilian Population

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Understanding the Veteran Culture vs. Civilian Population

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Service members who are diagnosed with TBI while in active duty may feel afraid or ashamed to speak up because of the possibility of being alienated from there comrades and/or displaying weakness.

The retired-aged veteran who has co-morbidities as result of active duty can develop a TBI from a fall.  The veteran may feel like a burden to family/friends because of the long-term care that may be needed.

Within the civilian population, TBI is not the result of battlefield combat.  It is commonly caused by motor vehicle accidents, sport injuries, firearms and falls.  Civilians do not exposed themselves to a battlefield that could inevitably result in a TBI.

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These disturbances have been adapted from the National Institutes of Health (2015):
Cognitive Disturbances:  Disturbed Consciousness, Impaired Attention, Slowed Processing of Thoughts, Memory Problems
Emotional Disturbances:
Functional Communication Impairments, Executive Dysfunction, Depression, Irritability, Agitation, Rage
Behavioral Disturbances:
Aggression, Disinhibition, Apathy, Sleep Disturbances, Headache
Physical Disturbances:
Visual Deficits, Ambulatory Impairment, Dizziness/Vertigo, Seizure Disorder

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Concerns for TBI in the Veteran Population 

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Concerns for TBI in the Veteran Population 

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TBI in the veteran population is concerning because it can lead to a multitude of disturbances.

Th disturbances described by the National Institutes of Health (2015),  are categorized as either cognitive, emotional, behavioral or physical.

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The plan of care for the veteran with a TBI needs to begin with the classification of the injury as either mild, moderate, or severe within the combat hospital or VA medical center.

The service member should not delay care, whether in the battlefield or as a retired personnel.  They immediately seek evaluation to help prevent long-term damage.

If the injuries are mild; stabilize the service member by ensuring adequate oxygenation is supplied to the brain and regulation of blood pressure to increase circulation to  the brain and other organs.

Mild injuries can progress to severe, if the proper neurological assessments are not done for at least 48 hours after injury (Department of Veteran Affairs, 2015).

If injuries are moderate or severe; the service member should be stabilized then immediately air evacuated from combat hospital or sent to another civilian hospital equipped for neuro-surgical intervention.

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A higher incidence of TBI can be seen between the years of 2007-2014.  This higher diagnosed pattern is related to service members who participated in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) (Bagalman, 2011).  The rise can be linked to advance high-impact artillery and the ability to assess and diagnose for TBIs more accurately related to technological advances (Bagalman, 2011).  The majority of the service members affected occurred in the army branch and were mild in classification (DoD, 2015).

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The Department of Defense had a total of 339, 462 service members diagnosed from 2000-2015.  Below is the statisitical data for the year the amount diagnosed with TBIs.
In the year 2000:  10,958 personnel
In the year 2001:  11,619 diagnosed
In the year 2002:  12,407 diagnosed
In the year 2003:  12,815 diagnosed
In the year 2004:  14,468 diagnosed
In the year 2005:  15,530 diagnosed
In the year 2006:  17,036 diagnosed
In the year 2007:  23,218 diagnosed
In the year 2008:  28,538 diagnosed
In the year 2009:  28,958 diagnosed
In the year 2010:  29,442 diagnosed
In the year 2011:  32,907 diagnosed
In the year 2012:  30,801 diagnosed
In the year 2013:  27,646 diagnosed
In the year 2014:  25,053 diagnosed
In the year 2015:  18,066
diagnosed

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Open and Closed Head Injury within the Battlefield

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Open and Closed Head Injury within the Battlefield

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A TBI is categorized 2 ways when classifying within the battlefield:

Closed Head Injury-  service member has received an injury to the head from a possible Humvee collision or blow to their head from a blast (Bagalman, 2011)

Open Head Injury- service member has received an injury to the head from penetrating shrapnel as a result of improvised explosive devices (IED), rocket propelled  grenades and land mines (Bagalman, 2011).

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Traumatic Brain Injury (TBI) is defined by the National Institute of Health (2015), " as an acquired brain injury that occurs when a sudden trauma causes damage to the brain.  The TBI can result when the the head suddenly hits an object, or object pierces the skull and enters the brain tissue."

The diagnosis of the TBI can be mild, moderate or severe and symptoms can range from excessive vomiting, seizures, slurred speech, blurred vision, dizziness, numbness, weakness, loss of coordination/consciousness, confusion, agitation, dilation of one or both pupils or inability to awaken from sleep (National Institute of Health, 2015)