wounded midterm
What things contributed to demoralization of the military?
* nixons policy of withdrawal and vietnamization; made war appear as a no win situation * false hope- reluctant to fight and engage thinking war could be over soon * every soldier had dif dates-unit cohesion weak * soldiers sent home just as they began to understand how to navigate country & war-replaced by someone w little knowledge * dissent on american home, racial discrimination in the US, sixties culture (disrespect authority), soldiers access to drugs, nature of war (draining psychologically), inadequate leadership, lowered moral
How is CRF and cortisol involved in the pathophysiology of PTSD?
* the sympathetic nervous system release CRF, which stimulates the pituitary gland to release ACTH which causes the adrenals to release cortisol * Cortisol stops production of epinephrine and norepinephrine = the threat is over * PTSD sufferers hypersecrete CRF and have subnormal (lower) levels of cortisol = there is no shut down of the fight or flight response, always on high alert
what caused the battle of nasiryah
March 23-29, 2003 * US convoy made wrong turn into the city and is ambushed * 11 killed * 6, including Jessica Lynch, were captured → Lynch, then a 19-year-old supply clerk with the 507th * * *Maintenance Company (based in Fort Bliss, Texas), was injured and captured by Iraqi forces after her group made a wrong turn and was subsequently ambushed on *March 23, 2003 near Nasiriyah, a major crossing point over the Euphrates River northwest of Basra *She was initially listed as missing in action (MIA). Eleven other soldiers in the company were killed in the ambush *Bloodiest day was the 23rd when 18 US soldiers were ambushed and killed around the Saddam Canal *By the 27th most of the fighting was done and switched to search operations
What was the last branch of the military to begin accepting African Americans?
Marines until Roosevelt signed order to end discrimination in military June 25, 1941
What does a blunt force injury consist of?
Man to Man combat → struck / hit Broken bones, blood, cracked skulls
first weapon used by man
Sticks with point → spear → used for hunting and self defense also used rocks and clubs
Michael Leone
the takeaways: * think team (take care of eachother) * build relationships (above all else) * don't be afraid to fail (take risks...good ones) * saw more deaths in training than in combat blackhorse → trained for 3 ½ years * train for safety → goal is to save a life, not take a life * biggest failure → hit brownout and hit a tank and those in tank dragged him out and saved his life * difficult for him that one of his colleagues was hurt because of him because of how much he desired to take care of his teammates * higher amount of non-OCO (non overseas) deaths compared to OCO (overseas) deaths * main casualty category was accidents * second was self-inflicted (veterans 2x higher risk for suicide)
What does Jeff discuss about treatment of injuries during active duty that probably contributes to worse outcomes overall? (Related to attitudes and norms among many military members) Family of veterans - how did they, especially his mom, respond to his news of deployment to Afghanistan?
toughing it out (taking tylenol for anything, not acknowledging when seriously injured especially in terms of mental health); not in favor of him going knowing what the experience was like for her
Hannibal and the Battle of Cannae - what animal was part of their strategy?
war of elephants
Jericho - what is significant about the layout of the city and what does it tell us about human society?
* existence proves early human societies positioned themselves w defense in mind * high stone wall, igloo shaped dwellings
how is national guard activated
* governor has authority to call them into state * any site with declared state of emergency * President can also enact under federal control
Factors for soldiers that increase risk of psychiatric injury?
* longer exposure to combat, greater risk of psychic injury * time in combat and intensity of combat * pre existing trauma history, attachment issues
Burns - what is involved in recovery?
* Treatment for burn critical care involves: Pain Relief Preventing Infections Maintaining body weight, fluids, and electrolytes *After the critical care period, they may be psychological counseling, outpatient physical therapy, and continued dressing and surgical treatment
Deaths from WWII - what was different about this war compared to those before it?
* World War II was the first war where there were more battle related deaths than deaths from other causes such as disease, accidents, and infections * The new nature of combat, from trench warfare in World War I to mobility in World War II, * changed the type of wounds sustained
What is Boyd's OODA theory? What is the OODA loop model meant to help with?
* Observe, Orient, Decide, and Act * Advocates for a form of maneuver warfare that is more psychological and temporal in its orientation than physical and spatial * Greater quickness permits the rapid concentration of friendly strength against enemy vulnerabilities * American pilots had clear advantages in Observing and Acting, the first and last stages of the OODA Loop. They were able to disrupt their adversary's process (in spite of the weaker equipment) due to better information and faster execution
What theory contributed to the military's policy of rejecting men for "psychiatric reasons"?
* Post - WWI - Theory advanced that certain individuals were predisposed to psychic trauma. * WW II - 1.6 million men rejected for "psychiatric reasons." * The U.S. lost 504,000 men (50 divisions) due to psychiatric collapse. * The Army recognizes that any individual will succumb to trauma at personal "breaking point."
Audiology
* Prevention, identification, and measurement of hearing loss and the rehabilitation of individuals with hearing loss, as well as the assessment of balance disorders * Help with assistive technology such as hearing aids
Demographics of Sadr city - Rich/poor?
* Sadr City is one of the poorest districts in all Baghdad, and one of the most densely populated. There is an estimated 2.0 million people living in an 8-sq-mile district, about the population of Houston. About half of Baghdad's population lives here. * Camp War Eagle just outside the city proper, to the east. The troops living and working there suffered continuous mortar attacks. * A troop changeover was occurring at this time at War Eagle * The people of Sadr City are part of the Shi'ite majority * POVERTY
Tactical Combat Casualty Care - what does it involve?
* Standardize set of procedures to treat U.S casualties across active-duty military services * Prioritizes reducing causalities over treatment, which serves to prevent the unit from incurring further causalities * Employ aggressive use of tourniquets and hemostatic agents to control bleeding as a form of "damage control" * With this, combat medics are trained to detect and stabilize the most easily preventable causes of battlefield deaths when under fire
What was the purpose of Nixon's "Vietnamization"?
* Start to withdraw troops to reduce US casualties and turn more of the war over to the Vietnamese * Only prolonged America's involvement and created hope for soldiers of returning home which made them more resistant to engage in battle
Five levels of trauma care used in the wars in Iraq and Afghanistan - where does level I care happen?
* Trauma care for US soldiers currently is provided through five levels of care * The nature of wounds sustained by service members in Iraq and Afghanistan has been transformed by suicide bombers, and Improvised Explosive Devices (IEDs) have contributed to limb amputations as a result of massive tissue damage from explosives. * In Iraq and Afghanistan, resuscitation begins on the battlefield (Level I) and continues during transport.
Battle of Nasiryah was part of what operation?
* thirty-three members of the Army's 507th Maintenance Company unknowingly drove directly through Iraqi prepared defenses in, and around, the ancient desert city of An Nasiriyah. * A series of misfortunes, poor decisions, and just plain - bad luck, had led this convoy into the jaws of death. * The battle for Nasiriyah was one of the bloodiest battles of Operation Iraqi Freedom. * 18 men were killed, and another 15 were wounded during the fight. * The Battle of Nasiriyah was fought between the US 2nd Marine Expeditionary Brigade and Iraqi forces from 23 March to 2 April 2003 during the US-led invasion of Iraq * Many mistakes were made by the coalition, and a lot of good men lost their lives, or had them permanently changed. * Ambush Alley was where the company took a wrong turn
"Catch a Lift" program - what is it?
A military family transformed a loss into a life-saving program for wounded veterans. Baltimore native Chris Coffland's family started the Catch A Lift Foundation after his death in Afghanistan six years ago. → Everyday Coffland would say "I'm goin' catch a lift"; his way of saying, he was off to the gym. In keeping with Coffland's commitment to fitness and his dedication to the wellness of others, CAL will assist wounded veterans to become physically and mentally fit again through gifted gym memberships * Through physical fitness you can achieve your highest potential for a healthy mind and body * Provides gym memberships and in home gyms to post 9/11 combat wounded veterans It is the veteran's responsibility to provide the gym information and contact person on the application form. * CATCH A LIFT will grant the yearly membership for the wounded veteran and if needed, the VA CAREGIVER, in compliance with the gyms and CATCH A LIFT's criteria * Started by the family of Christ Coffland's family, who had a dedication to mindfulness and physical fitness and encouraged others to participate as well to lead a healthier and well balanced lifestyles
max palumbo
Army - life in a combat outpost no electricity high temperatures slept in cots no sanitation burn pit for the bathroom one of the first priorities after safety was hand sanitation built a water tank for soldiers to wash their hands What advice did his wife give for supporting someone returning from the military? give them space allow time to decompress listen and learn about experience clue into signs of struggle
Typical wounds associated with IEDs and VBIEDs
Blast wave harms internal organs Burns Dismemberment Head injuries Puncture wounds Vision and Hearing Loss PTSD
What does Sebastian Junger suggest as the reason for why soldiers miss war?`
Brotherhood and connecting with the other men he was with * mutual agreement in a group that you will put the safety of the group over your own → "I love these other people more than I love myself" * Men are blessed with the experience of knowing In society, it is hard to know who to count on, who loves them, what people would do for them * When you go to war you realize who really cares about you and peoples true colors show. It's difficult when people you thought cared about you aren't there for you. * The worst is coming home and realizing its not your home anymore. * Coming home was the most depressed time for me because I had nothing to come home to anymore I had traveled all over the world, but I missed Vietnam the most. Because it's where I mattered. We all mattered to each other. But at home, there is no connection that is comparable. * They were the worst of times, and also the best times of my life"
What does the Triad of Care consist of?
Doctor, nurse case manager, squad leader
Physical Therapist
Focus on restoring function to improve mobility, relieve pain, and prevent or limit permanent physical disabilities of soldiers experiencing injuries or disease
Danielle Walker - African Americans/Blacks in the Military
Harlem Hellfighters - after WW2 black Americans were seen as threats "Red summer" - Red Summer is the period from late winter through early autumn of 1919 during which white supremacist terrorism and racial riots took place in more than three dozen cities across the United States, as well as in one rural county in Arkansas GI Bill - blacks had hard time accessing benefits Higher rates of PTSD d/t war zone stressed & discrimination
Cold Calculations article
How does the VA determine how much to pay a wounded Soldier for a disability claim? * Monthly compensation payments vary widely and be tough to estimate * Special monthly compensation payments vary widely and can be tough to estimate. The loss of a single foot, hand or eye is worth $101.50 a month. Two missing legs can generate an additional payment of about $1,000-$1,300 a month. Missing arms are worth an extra $1,600-$1,800
What preceded the creation of the National Institute of Mental Health? (NIMH)
In 1946, President Harry Truman passed the The National Mental Health Act, which created a significant amount of funding leading to the creation of the NIMH
what is fragging
Killing of an officer by his own men
During what war did the helicopter ambulance units begin operations?
Korean war - In 1951, the first helicopter ambulance unit began operations in Korea, transporting more than 17,000 wounded Soldiers to a sterile, fully equipped hospital in minutes by war's end in 1953.1
Florence Nightingale - diet, dirt, drains
Issues affecting healing during war * Bring in good food * Cleaning up the environment and wounds * Flushing out the sewers and improving ventilation *The soldiers were poorly cared for, medicines and other essentials in short supply, hygiene neglected, infections were rampant. * Nightingale found there was no clean linen; the clothes of the soldiers were swarming with bugs, lice, and fleas; the floors, walls, and ceilings were filthy; and rats were hiding under the beds. * no towels, basins, or soap, and only 14 baths for approximately 2000 soldiers. The death count was the highest of all hospitals in the region. * One of Nightingale's first purchases was of 200 Turkish towels; she later provided an enormous supply of clean shirts, plenty of soap, and such necessities as plates, knives, and forks, cups and glasses. * Nightingale believed the main problems were diet, dirt, and drains—she brought food from England, cleaned up the kitchens, and set her nurses to cleaning up the hospital wards. A Sanitary Commission, sent by the British government, arrived to flush out the sewers and improve ventilation.
Why did so many Soldiers suffer from TBI during the wars in Iraq and Afghanistan?
The increased use of IEDs (Improvised Explosive Devices) and a greater number of soldiers experiencing head injuries
Important medication discovered between WWI and WWII - what is the significance of it in treating injured soldiers?
Penicillin - injuries resulting from high-velocity projectiles extend beyond the immediate wound sites, requiring greater surgical debridement markedly to reduce risk of gas gangrene, late infection, and postoperative hemorrhage. World War II produced tremendous medical and surgical advances such as penicillin, which dramatically increased survivability
Speech and language pathologist
Prevention, Diagnosis, and treatment of a wide range of primarily expressive communication disorders = speech, language, and swallowing disorders
Survival stress reaction - what is this?
SSR is the fear activated heart increase in War → 70 BPM to 220 BPM in 220 BPM in ½ a second 70 BPM = normal 115 BPM = fine motor skills begin to deteriorate 115 - 145 BPM = optimal survival & combat performance / complex motor skills high functioning 145 BPM + = complex motor skills deteriorate, hearing shuts down 175 - 185 BPM = cognitive processing deteriorates 185 - 220 BPM = hypervigilance and irrational behavior, hyperventilation
What is the general role of each member of a medical rehabilitation team?
Successful treatment involves a team of medical professionals that have specialized knowledge of the rehabilitation process
Impact of the Cold War on American domestic life
The ever-present threat of nuclear annihilation had a great impact on American domestic life as well. * People built bomb shelters in their backyards. * They practiced attack drills in schools and other public places. * The 1950s and 1960s saw an epidemic of popular films that horrified moviegoers with depictions of nuclear devastation and mutant creatures. * In these and other ways, the Cold War was a constant presence in Americans' everyday lives
triaging
Triaging is the prioritization of patients based on the severity of their condition
Impact of gunpowder invention
Very revolutionary More bang for buck → larger number of soldiers, battles covered larger and larger areas More soldiers in support
Rehabilitation Nursing and Nurse Case Mgmt
the process of assessing, planning, organization, coordinating, implementing, monitoring, and evaluating the services and resources needed to respond to an individual's healthcare needs
What caused the majority of active-duty military deaths between 2006-2021?
accidents
"Ugh, I miss it" article
challenges derric faced * loneliness, inadequate sense of belonging * social support and relationships; working construction, marriage, divorce, alcohol, drugs, therapy, etc. * hard to find meaning and enjoyment in life * PTSD * isolation
neuropsychology
cognitive functions of the brain such as attention, language, and memory help develop medications and products related to brain function and health Perform research and work with patients
Who does the VA collaborate with to take care of wounded warriors?
department of defense
milton rodriguez- influenced him to start career in diplomacy
desire to limit fighting and learn how to prevent war through politics? continuing his studies at Tufts school of diplomacy hopes to work for the UN or state department as a diplomat "hopefully they resolve problems through peaceful negotiations rather than war, violence, dropping bombs. I feel like problems can be fixed much easier if you understand each other rather than fight it out. I think that's one thing that the military really taught me is that problems can be fixed another way because i've seen how military action fixes and violence fixes." if it wasn't for the military, would not have chosen this career path
What 2 neurotransmitters are involved in the fight/flight/freeze response?
epinephrine and norepinephrine
pattern of psychological responses to disaster
focus of care: strengthening psychological and behavioral immunity, supporting rebound, supporting recovery and moving on types of care: monitor psychological distress, promote wellness practices, leadership; psychiatric assessment, therapy, healing group, spiritual group
Rates of PTSD among African American and Hispanic Vietnam veterans
higher rates than white counterparts due to racial discrimination and war zone stresses
Michelle Patch
importance of flexibility I'd argue the motto that has resonated the most with me as it relates to career is the humbling, "Semper Gumby," or always flexible. For those who are not familiar with Gumby, he is a Claymation character created in the 1950s who, along with his equally flexible horse-friend, Pokey, have been beloved bendable toys for many kids and adults. The term "Semper Gumby" has been widely used for decades across the service branches to stress the need to be ready to pivot at a moment's notice
Relationship of projectile velocity and internal damage
more internal damage as velocity of projectile increased
What is the most common form of impairment among Soldiers?
partial loss of hearing is the most common form of impairment → soldiers often work in hazardous noise environments, and despite substantial efforts to protect hearing, a high occupational risk for hearing loss exists
Rehabilitation Counseling
professional counselors with specialty training in disability, medical aspects of disability, advocacy, career guidance and vocational assessments, and rehabilitation systems
Occupational Therapists
provides services to individuals of all ages who lives have been disrupted by physical injury ,developmental problems, the aging process, or social/psychological difficulties Evaluate soldiers ability to perform everyday tasks such as toileting, dressing, etc they need to do, tasks they are required to do (their job), and taks they want to do Modify and simplify tasks : adapt tools, objects or environment, match technologies to people's needs and preferences
If a person or a business wants to reduce physical barriers to participation for Soldiers with disabilities, what should they consider? (i.e. how do you make a place or an event accessible?)
ramps, curb-cuts, doorways, lighting, signage, and other accommodations are essential to promoting successful medical rehabilitation Barriers include: Sidewalk cracks Cars parked in front of curb-cuts Long inclines Long waits for elevators snow or ice buildup areas of long sun and heat exposure putting in maps of accessible routes sign language interpreters
how old is PTSD
shell shock term used in WWI * Artillery bombardment and "intense fear, helplessness, or horror" * Exaggerated startle response, stupor, traumatic dreams, irritability, trembling * W.H. Rivers - utilized Freud's "talking therapy" as well as oral and written trauma narratives
Psychiatrist & Psychologist
study and treatment of mental disorders
