Looking forward – March 2012

Nearly 2.3 million military men and women have been deployed to Iraq or Afghanistan in the last 10 years. Because of the advances in military medicine and protective gear, as well as the type of weaponry often used in these conflicts, the total number of casualties has been relatively low. However, approximately 50,000 veterans are returning home with serious bodily injuries, and one in six suffers from traumatic brain injury (TBI) or post-traumatic stress disorder (PTSD).

As the war drawdown continues and the pool of veterans grows, access to effective care for active and former military personnel will become increasingly crucial. Yet, with the exception of military and Veterans Affairs (VA) physicians, few clinicians are trained to meet the challenges associated with providing care for this population. The American College of Surgeons (ACS) is partnering with other health care organizations and the government to rectify this problem through its participation in a program known as “Joining Forces.”

Identifying veterans’ needs

A common misconception is that most veterans receive their medical and surgical care through the VA. Consequently, some surgeons and physicians who practice outside of the VA system believe they rarely, if ever, will be expected to deal with veterans’ unique health care issues. However, the fact of the matter is that more than 50 percent of veterans who have returned to civilian life have the same type of insurance coverage as other American workers. They have employer-based coverage and therefore seek care from physicians and other health care providers that participate in their insurance plans. So, all health care professionals need to be familiar with the unique physical and psychiatric problems that afflict a significant number of veterans.

As noted previously, many of the veterans have experienced multiple bodily injuries, a condition that the VA calls “polytrauma.” TBI is frequently seen in polytrauma patients, along with other disabling conditions, such as amputation, auditory and visual impairments, spinal cord injury, and so on. Due to the severity and complexity of their injuries, these patients may require an extraordinary level of coordinated and integrated clinical and support services, including care that only a surgeon can provide.

Many veterans—both those who were physically injured and those who were not—also are battling PTSD and other mental illnesses. The VA has reported 167,000 cases of PTSD, 195,000 cases of depressive conditions and affective psychoses, and 103,000 cases of anxiety disorders. These conditions put people at risk for suicide. Tragically, the suicide rate in the U.S. Army and Marine Corps has, for the first time on record, reached that of the civilian population, and the VA’s Veterans Crisis Line (800-273-8255) has received approximately 500,000 calls from returning veterans who are considering taking their own lives.

It behooves surgeons to get the training necessary to identify and help these patients locate the help they need. As trusted providers of patient care, all surgeons and other clinicians need to be able to detect when a veteran is reaching a mental breaking point. The VA offers many resources to help health care professionals understand TBI and PTSD, learn how screen for these conditions, and decide when to refer patients to mental health professionals. This information can be accessed from the National Center for PTSD and Polytrauma/TBI System of Care.

Joining Forces

I recently had the privilege of learning about the Joining Forces initiative, which First Lady Michelle Obama and Second Lady Jill Biden, EdD, are spearheading. Joining Forces is a broad program designed to bring the government and the private sector together to ensure that veterans have access to jobs, higher education, and health care. (More information regarding the Joining Forces program is available online.)

In an effort targeted at addressing the health care component, in January, the White House, the Department of Defense (DoD), and the VA convened a roundtable program for leaders of an impressive number of health care organizations (see list at left). This discussion centered on how the medical and surgical communities can work together and with the government to better meet the neurological and psychological needs of our nation’s returning servicemen and women.

Since the roundtable, the ACS and other groups represented at the meeting have started taking steps to mobilize their members to improve care for veterans and active service members. For example, the Association of American Medical Colleges (AAMC) and the American Association of Colleges of Osteopathic Medicine (AACOM) have joined forces to ensure that 130 of the nation’s medical and osteopathic colleges provide future health care professionals with training in the treatment of TBI, PTSD, and so on.

ACS involvement

Through the Joining Forces initiative, the College is partnering with the AAMC, the AACOM, and other participating organizations to collectively improve the quality of care that vets receive. The College is undertaking a number of projects independently as well to help arm surgeons with the skills they need to provide appropriate, compassionate care to wounded warriors. First, the ACS Committee on Trauma website, is being updated to provide information about the Joining Forces initiative and the VA and DoD resources that are available to clinicians. Additionally, the next edition of the Advance Trauma Life Support® manual will contain information on PTSD.

Furthermore, the Division of Education is developing a session on Joining Forces for presentation on October 2, at this year’s Clinical Congress in Chicago, IL. Staff is working with several Fellows who have ties to the military to put together what should be a fascinating and inspiring panel discussion.

I encourage each of you to participate in these programs, so that you can make a difference in the lives of your veteran patients. Ask them about their experiences during deployment and assess their risk for problems.

Also, think about taking a continuing education course in working with patients with TBI and PTSD. The VA offers several Web-based training courses for clinicians, including “PTSD 101” and an independent study course on TBI.

As the College and its Fellows seek to ensure that all patients receive high-quality care, we must not abandon the men and women who risked their lives and whose families made enormous sacrifices on our nation’s behalf. They truly deserve the best and most compassionate care we can provide.

Roundtable participant organizations

American College of Surgeons
American Academy of Family Physicians
American Academy of Neurology
American Academy of Nurse Practitioners
American Academy of Pain Medicine
American Academy of Pediatrics
American Academy of Physical Medicine & Rehabilitation
American Academy of Physician Assistants
American Association for Family and Marriage Therapy
American Association of Colleges of Osteopathic Medicine
American College of Emergency Physicians
American College of Obstetricians and Gynecologists
American College of Physicians
American Medical Association
American Nurses Association
American Osteopathic Association
American Physical Therapy Association
American Psychiatric Association
American Psychiatric Institute for Research & Education
American Psychological Association
Association of Academic Health Centers
Association of American Medical Colleges
National Area Health Education Center Organization
National Association of Social Workers
National Board for Certified Counselors
Physician Assistant Education Association


The data in this column were supplied through personal communications with representatives of the VA and are drawn from the Joining Force website listed in the text.

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