The Visible and Invisible
Wounds of Today’s Veterans
Philip Larson
U-M Veteran and Military Services
Disclaimers
• This presentation may be a trigger for those
who have experienced combat
• This is heavy material
• Some of ...
Brief History of Injuries in Combat
• WWI – trench foot, gas, lice, shell shock
– 4% survival rate
• WWII – artillery/bomb...
Iraq (OIF) Afghanistan
• Iraq War (OIF) 2003-2011
– Modern Country, Cities,
Roads/Highways
– Urban warfare, Countryside,
I...
Combat Trauma
• Physical Visible
• Physical Hidden
• Psychological Visible
• Psychological Hidden
IED
• http://www.youtube.com/watch?v=XLR127_I9sw
• http://www.youtube.com/watch?v=rNx3-R13FtA
IED Wounds
• Roadside and footpath blasts
• Limb loss – 11% lost more than one limb
• Genital injuries
– (often combined w...
Sniper Fire
• High velocity rounds
• Head and Neck wounds
• Psychological Trauma
Combat
http://www.youtube.com/watch?v=b9Pq5JZ2Fd8 (6:07 – 12:00)
• Explosive devices/rounds
• Non-explosive rounds
• Rocke...
Accidents
• Aviation
• Ground
• Transportation to battlefield
• Accidents
• Faulty equipment
TBI
• Caused by sudden trauma to the head or a
penetrating head injury, that disrupts the
normal functioning of the brain....
TBI
• Mild TBI
– Headaches or neck pain that does not go away.
– Light-headedness, dizziness or loss of balance.
– Urge to...
TBI
• Severe TBI
• Headache that gets worse or does not go away.
• Repeated vomiting or nausea.
• Convulsions or seizures....
TBI
• Compounding issues
– Delay in treatment
– Repeated concussive events
• Increases risk of
– Alzheimer’s Disease
– Par...
TBI
• Diagnosis
– Military Acute Concussion Evaluation
– CT Scan
– MRI
– Single Emission Computed Tomography
– Positron Em...
Psychological
• 2012 SVA Survey:
0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%
Severe Anxiety
Severe Depressive Symptoms
Signi...
Stories
• Fallujah family home
• Convoy Duty
• M1 Tank
PTSD
• Experience or witness of an event that
involved actual or threatened death or injury
• Response involves intense fe...
PTSD
Re-experience the event
• Recurrent and intrusive recollection of the
event
– Images, thoughts, perceptions
• Dreams
...
PTSD
• Responses
– Avoidance
• Thoughts, feelings, conversations
• Activities, places, people
– Inability to recall event ...
PTSD
• Physical arousal
– Difficulty falling or staying asleep
– Irritability or outbursts of anger
– Difficulty concentra...
PTSD
• Treatment
– Safety and Security
– Telling the story
• talking, art, writing, acting
– Remembering
– Dealing with th...
From a veteran’s perspective
(ten things you should know about todays student veteran)
• Student Veterans are a highly div...
Veteran’s perspective cont.
• Female soldiers suffer in silence
– 15% of military
– 22% of whom will be sexually assaulted...
Documentaries
• The Battle for Marjah
• Restrepo
• Korengal
http://www.youtube.com/watch?v=jw_anreJjow&list=PLHQ5K79eN3JSQ...
References
• http://www.bbc.co.uk/schools/0/ww1/25403864 - WWI Injuries
• http://www.netplaces.com/world-war-ii/the-horror...
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The visible and invisible wounds of today's veterans

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Philip Larson, Military Veterans Director at the University of Michigan presents on the visible and invisible wounds experienced by today's veterans.

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The visible and invisible wounds of today's veterans

  1. 1. The Visible and Invisible Wounds of Today’s Veterans Philip Larson U-M Veteran and Military Services
  2. 2. Disclaimers • This presentation may be a trigger for those who have experienced combat • This is heavy material • Some of what I will say and discuss may disturbing • I am not a doctor, clinician, social worker or therapist • I have never served in combat
  3. 3. Brief History of Injuries in Combat • WWI – trench foot, gas, lice, shell shock – 4% survival rate • WWII – artillery/bombs, malaria – 69.7% survival rate • Korea – cold weather, agent orange – 75.4% survival rate • Vietnam – agent orange, environmental – 86.5% survival rate • Gulf War – Chemical/Biologic, Immunizations • Today – 90% survival rate
  4. 4. Iraq (OIF) Afghanistan • Iraq War (OIF) 2003-2011 – Modern Country, Cities, Roads/Highways – Urban warfare, Countryside, IEDs • Afghanistan War (OEF) 2001 - Present – Mountainous, some cities – Rural Insurgency
  5. 5. Combat Trauma • Physical Visible • Physical Hidden • Psychological Visible • Psychological Hidden
  6. 6. IED • http://www.youtube.com/watch?v=XLR127_I9sw • http://www.youtube.com/watch?v=rNx3-R13FtA
  7. 7. IED Wounds • Roadside and footpath blasts • Limb loss – 11% lost more than one limb • Genital injuries – (often combined with double amputation of legs) • Shrapnel wounds • Burns • TBI • Psychological Trauma
  8. 8. Sniper Fire • High velocity rounds • Head and Neck wounds • Psychological Trauma
  9. 9. Combat http://www.youtube.com/watch?v=b9Pq5JZ2Fd8 (6:07 – 12:00) • Explosive devices/rounds • Non-explosive rounds • Rocket propelled grenades • Shoot downs • Friendly Fire • Psychological Trauma
  10. 10. Accidents • Aviation • Ground • Transportation to battlefield • Accidents • Faulty equipment
  11. 11. TBI • Caused by sudden trauma to the head or a penetrating head injury, that disrupts the normal functioning of the brain. • Blasts are leading cause in combat zones • Person may remain conscious or be dazed or confused after injury takes place • Symptoms are subtle and may not occur for days or weeks following the injury.
  12. 12. TBI • Mild TBI – Headaches or neck pain that does not go away. – Light-headedness, dizziness or loss of balance. – Urge to vomit (nausea). – Loss of sense of smell or taste. – Ringing in the ears. – Difficulty remembering, concentrating or making decisions. – Slowness in thinking, speaking, acting or reading. – Getting lost or easily confused. – Feeling tired all of the time and having no energy or motivation. – Mood changes (feeling sad or angry for no reason). – Changes in sleep patterns (sleeping a lot more or having a hard time sleeping). – Increased sensitivity to lights, sounds or distractions. – Blurred vision or eyes that tire easily.
  13. 13. TBI • Severe TBI • Headache that gets worse or does not go away. • Repeated vomiting or nausea. • Convulsions or seizures. • Inability to awaken from sleep. • Dilation of one or both pupils of the eyes. • Slurred speech. • Weakness or numbness in the extremities. • Loss of coordination. • Increased confusion, restlessness or agitation.3
  14. 14. TBI • Compounding issues – Delay in treatment – Repeated concussive events • Increases risk of – Alzheimer’s Disease – Parkinson’s Disease – Dementia
  15. 15. TBI • Diagnosis – Military Acute Concussion Evaluation – CT Scan – MRI – Single Emission Computed Tomography – Positron Emission Tomography – Cognitive Evaluations – Physical, Occupational and Speech Evaluations
  16. 16. Psychological • 2012 SVA Survey: 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% Severe Anxiety Severe Depressive Symptoms Significant PTSD symptoms Thoughts about suicide
  17. 17. Stories • Fallujah family home • Convoy Duty • M1 Tank
  18. 18. PTSD • Experience or witness of an event that involved actual or threatened death or injury • Response involves intense fear, helplessness or horror • Moral injury • Can be acute or chronic
  19. 19. PTSD Re-experience the event • Recurrent and intrusive recollection of the event – Images, thoughts, perceptions • Dreams • Act as though the event was recurring • Reaction to “triggers”
  20. 20. PTSD • Responses – Avoidance • Thoughts, feelings, conversations • Activities, places, people – Inability to recall event or pieces of event – Feeling of detachment – Restricted emotions – Inability to look ahead – Shame, Guilt, Loss
  21. 21. PTSD • Physical arousal – Difficulty falling or staying asleep – Irritability or outbursts of anger – Difficulty concentrating – Hypervigilance – Exaggerated startle response
  22. 22. PTSD • Treatment – Safety and Security – Telling the story • talking, art, writing, acting – Remembering – Dealing with the moral injury – Managing Triggers – Sleep management – Concentration – Emotional management
  23. 23. From a veteran’s perspective (ten things you should know about todays student veteran) • Student Veterans are a highly diverse group • Veterans do not see themselves as victims, ever! • They can feel alone on campus • They are often unaware of their PTSD or TBI • There are three things you should never say to a veteran but they still hear them every day – These wars were atrocities and a waste of human life. – I don’t understand what you’re having trouble – you volunteered for service. – Did you kill anyone?
  24. 24. Veteran’s perspective cont. • Female soldiers suffer in silence – 15% of military – 22% of whom will be sexually assaulted during their military service • They often want to go back to the war zone • Combat trauma is an injury not a mental illness • Veterans need your understanding, compassion and respect • Student Veterans are one of America’s greatest untapped human resources
  25. 25. Documentaries • The Battle for Marjah • Restrepo • Korengal http://www.youtube.com/watch?v=jw_anreJjow&list=PLHQ5K79eN3JSQEpnE pDavx5ziqkrWY2cD
  26. 26. References • http://www.bbc.co.uk/schools/0/ww1/25403864 - WWI Injuries • http://www.netplaces.com/world-war-ii/the-horrors-of-war/battlefield- injuries-and-medicine.htm - WWII injuries • http://www.va.gov/oaa/pocketcard/korea.asp - Korea injuries • http://www.federallabs.org/news/top-stories/articles/?pt=top- stories/articles/0609-03.jsp - survival rates • http://www.nea.org/home/53407.htm - Ten Things You Should Know About Today’s Student Veteran • http://www.realwarriors.net/active/treatment/tbisigns.php - TBI signs and symptoms • University of Michigan P.A.V.E program – SVA statistics • Williams, Mary Beth, Ph.D., LCSW, CTS & Poijula, Soili, Ph.D. (2002) . The PTSD Workbook, Oakland, CA, New Harbinger Publications

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