1 / 40

The Nature of Current Combat

Unique Considerations in the Treatment of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) Service Members. The Nature of Current Combat. Traditional elements of war: Firefights Observing injury and death Feelings of horror and helplessness.

maylin
Download Presentation

The Nature of Current Combat

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Unique Considerations in the Treatment of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) Service Members

  2. The Nature of Current Combat • Traditional elements of war: • Firefights • Observing injury and death • Feelings of horror and helplessness

  3. Traditional elements of war (con’t): • Boredom “In combat, there’s two things…bored out of your mind or scared out of your mind…and some of us like scared to death because it makes the time go faster”

  4. Traditional elements of war (con’t): • Long work hours • Not uncommon for soldiers to work 13-hour shifts for 2 to 3 weeks at a time • During sustained operations, combat soldiers often get less than 4 hours of sleep per night

  5. Issues specific to the current conflicts: • Sandstorms – Iraq averages 4 to 6” of rain/year, wind gusts can reach 50 mph • Sand covers homes, clogs equipment, causes breathing ailments

  6. Issues specific to the current conflicts: • Heat • Average summer temperature is 120 degrees F • Temperatures up to 152 degrees F have been recorded

  7. Issues specific to the current conflicts: • Insurgency warfare • Unlike traditional warfare, insurgents mix into the populace, making it unclear who is friend and who is foe. “You don’t know who to shoot until they start shooting at you”

  8. Issues specific to the current conflicts: • Ambiguity surrounding the rules of engagement • Female suicide bombers • Checkpoints in which shoot/no shoot decisions must be made in seconds

  9. Issues specific to the current conflicts: • Insurgency warfare • Research has found that ambiguity and the need to restrain force can result in feelings of fear, frustration, anger, and resentment2

  10. There is no front line - • Attacks can happen anywhere Mosul mess hall: Dec. 21, 2004, after a large explosion that left 22 dead Associated Press, Aug. 19, 2005

  11. Issues specific to the current conflicts: • Improvised Explosive Devices (IEDs) “I have come to hate garbage in a whole new way…”

  12. Issues specific to the current conflicts: • Urban warfare • Complex battle space • Buildings conceal enemies and channel soldiers’ movement • Decentralized Troops

  13. Ready access to e-mail and phone contact with partners and family members • Allows for immediate access to issues at home (finances, parenting, etc.) • A study by the Army War College indicates that this heightened contact with family lessens soldiers’ focus on combat3 • Homemade warzone videos are common online (“the first YouTube war”)4

  14. Who is serving in OEF/OIF? • National Guard and Reserves represent about 40% of those serving • Train 1 weekend per month and 2 weeks per year • Need to put civilian careers on hold • DOD reports that 41% of Reservists earn less while deployed than in their civilian jobs • Older recruitment age • Limit raised from 34 to 39 years old

  15. No Women in Combat?? • Increasing numbers of women serving • Women are officially prohibited from serving in direct combat, but reports show that large numbers of women are participating in combat operations • Women have received Army Commendation Medals, Purple Hearts, and Bronze Stars

  16. 86% Know someone who was seriously injured or killed.

  17. 77% Have shot at or directed fire at the enemy

  18. 68% Have seen dead or seriously injured Americans.

  19. Reintegrating Into Civilian Life

  20. Coming home to…. • Strained economy making it hard to find jobs • Family/marital issues – families cannot relate • Financial issues leading to stress • Homelessness for many • Lack of knowledge about their benefits • National Guard have little support compared to Active Duty working daily in military jobs

  21. Legal Problems • Driving while impaired, aggressive driving, Motor Vehicular Accidents • Domestic violence & Child Abuse • Emotional crisis • Drug & alcohol related incidents • Precipice of committing suicide or worst case scenario = completion

  22. Common Issues for Post-Deployment Combat Veterans (CV) • Traumatic Brain Injury • Post Traumatic Stress Symptoms • Alcohol and Drug Abuse • Military Sexual Trauma • Depression • Suicidal and Homicidal Ideation • Physical Exposures

  23. Causes of TBI • Head sustains blunt trauma or is violently shaken, (ex. MVA, blast or explosion), a concussion or closed head injury can result. • Sound waves that travel from explosions can damage can effect soft tissue (brain, eyes) even up to 500 feet away. • Multiple deployments can lead to multiple concussions which may have more serious problems- 3X Greater after 1st TBI • Improvised Explosive Devices IEDs, and Rocket Propelled Grenades RPGs, often result in devastating injuries such as amputations, sensory loss and brain damage. • There is currently no cap/limit on re-deployments, so the likelihood of further trauma is increased with multiple deployments.

  24. TBI Symptoms • Memory Issues – Short-term/Amnesia • Impulsivity • Poor Judgment - Irrational thinking • Difficulty Understanding • Depression and Mood Swings • Headaches • Hearing Loss and Tinnitus • Lack of physical coordination

  25. Trauma Symptoms • Difficulty sleeping, recurring nightmares • Intrusive Thoughts • Hyper-vigilance, feeling on guard, and scoping the environment • Startle reaction • Anger, aggression • Withdrawal, isolation • Trying to avoid thoughts or reminders of the traumatic event

  26. What Are the Triggers • Sudden Loud Noises – Fireworks!! • Crowds (depends on individual deployments) • Traffic, man holes, culverts, roadblocks • Trash on side of the Road • “Stupid people,” especially at work • Ineffective Processes • Mid/Eastern dress, language, buildings, • Not being PREPARED- creates tension in family

  27. Identifying Triggers • Ask the Question, “What’s different now?” or what seems to set you off? • This will be individual for each person, based on their particular , with commonalities • Give them HOPE and sense of CONTROL. Push them as soldiers to “take on the mission of recovery.” • SM are task oriented and trained to complete missions (tasks). Use treatment plan as an “operational order.”

  28. Trauma Effects the Brain • Survival Instinct of Fight/Flight/Freeze. Adrenaline can be addicting-risky behaviors • Limbic center (emotional-no sense of time) control reactions, NOT the frontal lobe (rational/logical). • Cannot separate the past dangers from present due to learned responses • Hyper arousal causes anxiety, insomnia, • Family, friends do not have war experience (and SM does not want them to know) so they will not react/prepare the same ways

  29. How to Treat Triggers • Provide insight into the Life/Death reactions that no longer apply in country, i.e. traffic • Honor the “Learned Response” – This helped the SM survive WAR and served them well • Provide education to SM and family on Fight/Flight, Adrenaline Reactions, and PTSD symptoms in a recovery format • Use Cognitive Restructuring to identify that these triggers no longer represent danger

  30. Dealing with Avoidance • Avoidance is most common way of dealing with triggers that cause anxiety • Continued avoidance sustains the trigger • Overexposure to triggers may exacerbate the symptoms, nightmares, intrusive thoughts • Teach SUDS scale 1-10 to SM and encourage them to approach anxiety to a 5-6 level • Encourage them to retreat when at over 6

  31. Issues to Address In Treatment • Defining Reintegration issues and PTSD symptoms • Recovery model • Anger Management • Cognitive Restructuring – A-B-Cs • Guilt and Forgiveness • Family Issues – Impact of symptoms

  32. Recovery Concepts • Independence • Empowerment • Satisfying Relationships • Quality of life • Meaningful Activity

  33. Take home points… • The soldiers we are currently treating are different than those we’ve treated in the past for several reasons • These differences have implications for treatment • We have a professional and ethical duty to familiarize ourselves with the cultures of those whom we treat

  34. OEF/OIF/OND CONTACTS • Christopher.Wilkes@va.gov • Shreveport – 318 990-4978 • Laura.Campbell3@va.gov • Shreveport – 318 990-5012

  35. References • La Bash, H. A. J., Vogt, D. S., King, L.A., & King, D. W. (2009). Deployment stressors of the Iraq War: Insights from the mainstream media. Journal of Interpersonal Violence, 24, 231-258. • Litz, B.T. (1996). The psychological demands of peacekeeping for military personnel. NCP Clinical Quarterly, 6, 1-8. • Lubold, G. (2006). Family contact cuts combat focus, study finds. Air Force Times, 66, 36. • Anden-Papadopoulos, K. (2009). US soldiers imaging the Iraq War on YouTube. Popular Communications, 7, 17-18. • Seal, K. H., Metzler, T. J., Gima, K. S., Bertenthal, D., Maguen, S., & Marmar, C. R. (2009). Trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans using Department of Veterans Affairs health care, 2002-2008. American Journal of Public Health, 99, 1651-1658. • www.va.gov – Search any Veteran’s topic • www.ptsd.va.gov • Militaryonesource.com • http://www.samhsa.gov/ for publications on trauma

More Related