As wounded come home, questions arise

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As wounded come home, questions arise




By Marilynn Marchione - The Associated Press
Posted : Sunday Jun 24, 2007 17:47:08 EDT

TAMPA, Florida — More than 800 of them have lost an arm, a leg, fingers or toes. More than 100 are blind. Dozens need tubes and machines to keep them alive. Hundreds are disfigured by burns, and thousands have brain injuries and mangled minds.
These are America’s war wounded, a toll that has received less attention than the 3,500 troops killed in Iraq. Depending on how you count them, they number between 35,000 and 53,000.
More of them are coming home, with injuries of a scope and magnitude the government did not predict and is now struggling to treat.
“If we left Iraq tomorrow, we would have the legacy of all these people for many years to come,” said Dr. Jeffrey Drazen, editor-in-chief of the New England Journal of Medicine and an adviser to the Department of Veterans Affairs, known as the VA.
“The military simply wasn’t prepared for its own success” at keeping severely wounded soldiers alive, he added.
Survival rates today are even higher than the record levels set early in the war, thanks to body armor and better care. For every American soldier or Marine killed in Iraq, 15 others survive illness or injury there.
Who are the wounded?
Unlike in previous wars, few have been shot. The signature weapon of this war, the improvised explosive device, or IED, has left a signature wound: traumatic brain injury.
Soldiers hit in the head or knocked out by blasts — “getting your bell rung” is the military slang — sometimes have no visible wounds but a fog in their minds. They can be addled, irritable, depressed and unaware they are impaired.
Only an estimated 2,000 cases of brain injury have been treated, but doctors think many other cases have gone undetected. One small study found that more than half of one group of wounded arriving at Walter Reed Army Medical Center in Washington had brain injuries. Around the nation, an effort is under way to check every returnee for this possibility.
Some of those on active duty may have subtle brain damage that was missed when they were treated for visible wounds. Half of those wounded in action return to duty within 72 hours — before some brain injuries may be apparent. The military just adopted new procedures to spot these cases, too.
Back home, concerns grow about care. A scandal over a deteriorating facility at Walter Reed hospital and problems with some VA nursing homes have led to demands for better care for veterans.
A lucky few get first class care at one of the VA’s four polytrauma centers, where the most complex wounds are treated with the latest techniques and devices like “power knee” or “smart ankle” prosthetics. Others battle bureaucracy just to see doctors or get basic benefits.
Mental health problems loom large. More than a third of troops received psychological counseling shortly after returning from Iraq, and a third of those were diagnosed with a problem, a Pentagon study found. The government plans to add 200 psychologists and social workers to help treat post-traumatic stress disorder.
No one knows what the ultimate cost will be. Harvard University economist Linda Bilmes estimates the lifetime health care tab for these troops will be $250 billion-$650 billion — a wide range but a huge sum no matter how you slice it. “The mistake in Vietnam was, we hid the injured away from folks so they didn’t get to tell their stories. Now it’s important that we let them tell their stories to the public,” said Dr. Steven Scott, director of the Polytrauma Rehabilitation Center at the Tampa VA Medical Center in Florida.
Counting the wounded can be contentious. Earlier this year, the Department of Defense changed how it tallies war-related injuries and illness, dropping those not needing air transport to a military hospital from the bottom-line total.
Bilmes, the Harvard economist, thinks this is disingenuous.
“An accident that happens while they’re there is a cost of war, particularly when you factor in the length of deployment” and injury-inducing conditions like hot weather, heavy back packs, and more vehicle accidents because it is not safe to walk in most places, she said.
As of early June, 25,830 troops had been wounded in action. Of these, 7,675 needed airlifts to military hospitals and the rest were treated and remained in Iraq.
There were another 27,103 non-battle air transports. Of those, 7,188 had injuries. Most occurred from vehicle accidents, training or work accidents. Ten percent were sports injuries, said Dr. Michael Kilpatrick, who tracks this information for the Defense Department.
Nearly 20,000 of these “non-hostile” airlifts were for illnesses or medical issues: general symptoms like fever or pain needing tests or evaluation; back problems; psychological problems adjusting to the war zone; “affective psychoses” (not able to function); neuroses; respiratory or chest symptoms; head and neck problems (including traumatic brain injury); epilepsy; infections, and muscle pulls and strains.
For stress-related problems, the military tries “three hots and a cot” — warm meals and a chance to sleep. Most of the time it works and troops return to their unit, Kilpatrick said.
Of the troops air evacuated to the main U.S. military hospital abroad, in Landstuhl, Germany, 20 percent return to Iraq and 80 percent go back to the U.S. for more care or disability discharge.
Of the half-million troops who have left active duty and are eligible for VA health care, about one-third have sought it. The most complicated cases end up at one of the four polytrauma centers, in Tampa, Florida; Richmond, Virginia; Palo Alto, California; and Minneapolis, Minnesota.
These were formed after doctors realized they were missing problems — amputees who were confused and unable to put on their prosthetics because of undiagnosed brain injuries, and guys who could who could carry on a conversation but not recall what they had for breakfast.
Troops at these hospitals have an average of six major impairments and 10 specialists treating them.
“The important thing to realize is you could have all of them at once” — trouble speaking, seeing, walking, hearing, and other ailments, Scott said.
Most of these injuries are caused by IED blasts, which send a pressurized air wave through delicate tissues like the brain, sometimes smacking it against the skull and shearing fragile nerve connections that control speech, vision, reasoning, memory and other functions. Lungs, eardrums, spinal cords — virtually anything — can be damaged by the pressure wave.
In prior wars, one of every five to seven troops surviving a war wound had a traumatic brain injury, the military estimates. It’s much higher now — a pilot project at Walter Reed in 2003 to screen 155 patients returning from Iraq found that 62 percent had a brain injury.
“This is a very rapidly evolving area as a disease,” with no screening test or agreed-upon set of symptoms for diagnosis, said Kilpatrick, the military doctor.
But the number of wounded returning is giving military doctors the opportunity to learn how to better treat them, he said.
“It’s just amazing to me every day when I look at these numbers,” he said. “The good news is that the majority of these people who become ill or injured ... are going to survive and are going to be able to return either to the military or to civilian life and be productive.”



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