Monday, February 5, 2007

Surviving After Combat: Soldiers Live, But at What Cost?

America’s current "war on terror" is unlike any that the nation has fought in its history. The battlefronts spread out over several countries, the tactics employed by both friends and foes are unconventional, and technology has drastically altered the combat environment. New technologies are being implemented in command and control systems, weapons, and of particular interest, medical treatment of injured soldiers in abroad and at home. Indeed in Iraq and Afghanistan, state of the art field hospitals are allowing unprecedented levels of care for those who can be evacuated form the combat zone. And while these field hospitals are able to save lives that would surely otherwise be lost, they create unique new problems that are as unprecedented as the fields of combat that cause them. These problems are not only physical but psychological. They arise from soldiers who survive that would have previously been lethal wounds and then must reenter a mostly peacetime society. It falls to us, as the members of that society to both acknowledge these unique challenges faced by returning soldiers, and do what is in our power to support their rehabilitation and reincorporation to life here at home.

To understand the situation it is important to have a basic knowledge of the incredible levels of health care being provided by the field hospitals in places such as the 21st combat support hospital (or CSH) near Balad, a city just north of Baghdad in Iraq. Because allied forces have nearly unchallenged air superiority in Iraq the first stage of care for an injured soldier is often a medical transport helicopter. These field units are often able to assess and prepare their patients for surgery as they leave the combat zone. The next stop is a combat support hospital, which is staffed by both military and civilian doctors.

These hospitals are on the cutting edge of medical technology and are able to provided services previously unheard of in a combat zone. For instance the 31st CSH reported preforming over 80 neurosurgeries in three months in early 2004. It is truly remarkable that field surgeons are able to perform brain surgery within hours of the initial injury. Such capabilities have saved hundreds of lives throughout the duration of the war.

However the effort does not stop there, because the primary mission of the field hospitals is only to stabilize its patients for more encompassing treatment elsewhere. Most patients treated in the CSHs are transported out of the combat zone to permanent hospitals in Allied countries such as Germany to undergo prolonged care before being brought back to Walter Reed Army Medical Center here in the United States.

This entire process is carried out with impressive haste. Soldiers that need to be removed from active duty normally leave Iraq within 72 hours, and are back in the US in a matter of weeks. However most of these soldiers return with life changing injuries. Because the field hospitals are able to do so much, survivors are returning with injuries that are as unprecedented as the technologies that saved them. In the case of Iraq in particular, the type of injuries that are most common, such as those from improvised explosive devices, are severe head injuries that result in trauma to the brain which is irreversible. And while the field hospitals are saving lives, they cannot promise a full recovery.

One field surgeon from Iraq in a interview with Washington Post acknowledged the sucess of thier medical operation, while aluding to emotional and moral dilemas that it caused, saying "We're saving more people than should be saved, probably,” in regards to a patient who was alive, but was going to loose a significant amount of brain function. Another doctor, Maj. Richard Gullick stated that most soldiers returning after having a traumatic brain injury will have permanent disabilities that are similar to those that occur from mild or moderate strokes. Furhtermore a full quarter of those patients would have severe disabilities. There are indeed some accounts of soldiers coming home in permanent comas, which forced their families to decide whether or not to continue life support.

Cases like these are difficult for not only the soldiers, but the families and communities they return to. It is imperative that we as a people understand and empathize with the situations these families face and help them overcome their hardships. And while the Veterans Authority has been tackling these issues for years, many private and federal projects have started to address these issues such the Intrepid Foundation. The Foundation recently opened the Center for the Intrepid. The facility is a physical rehabilitation hospital that provides the highest levels of care to help return its patients to productive daily lifestyles. While this represents a great step forward, it should be just one of many to follow. Hopefully similar initiatives will help create centers that are just as advanced that focus on psychological and emotional rehabilitation for the grievously injured.

EDIT 3-5-07: There has been a large investigation of the failures of the Army to deal with its injured veterans, to learn more please see this CNN article

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