1. WHEN WAR COMES HOME THE IMPACT ON OKLAHOMA COMMUNITIES

2. Analysis of VA Health Care Utilization among Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) Veterans. Cumulative from 1 st Qtr FY 2002 through 2 nd Qtr FY 2014 (October 1, 2001-March 31, 2014) Suggested citation: Epidemiology Program, Post- Deployment Health Group, Office of Public Health, Veterans Health Administration, Department of Veterans Affairs, (2014) Check http://publichealth.va.gov/epidemiology for updateshttp://publichealth.va.gov/epidemiology

3. October 1, 2001- March 31, 2014 5,851 have died in-theater.

4. 2.6 Million Troops have served or are serving in the two theaters of operation since the beginning of the conflicts

5. 1,791,420 OEF, OIF, OND veterans have left active duty since FY 2002

6. OKLAHOMA VETERAN STATICS http://www.va.gov/vetdata/Veteran_Population.asp http://www.va.gov/vetdata/docs/Maps/VetPop_State.pdf http://www.va.gov/vetdata/docs/Maps/VetPop11_Under25.pdf http://www.va.gov/vetdata/docs/Maps/VetPop_Percent_Under25.pdf

7. Now or Later Video

8. CHALLENGES OF OEF AND OIF No “front line” Highly ambiguous environment Complex and changing missions – combat, peacekeeping, humanitarian Long deployments Repeated deployments Environment is very harsh – extreme heat – 24 hour operations – constant movement by ground or air – limited down time – crowded uncomfortable living conditions – difficult communications

9. COMBAT EXPERIENCES  Being attacked or ambushed  Being hit by or exposed to IED, directly/indirectly  Receiving incoming artillery, rocket, or mortar fire  Being shot at, receiving small arms fire  Shooting or directing fire at the enemy  Being responsible for the death of enemy combatant  Seeing dead bodies or human remains  Knowing someone severely injured or killed in action  Seeing ill or injured women or children whom you were unable to help

10. Stressors in the Deployment Cycle Pre-deployment Notification Preparation Training Return from Deployment Reunion Reintegration Deployment Departure Sustainment Combat and conflict

11. MINDSET WHEN DEPLOYED Stay focused on mission /nothing else matters Truly life or death / always on the edge Constant adrenaline “rush” Black or white / all or nothing Sense of purpose, invincibility Only trust battle buddies /others are threat Need to control environment Real problems and needs exist in Iraq/Afghanistan Adapted from briefing by COL Kevin Gerdes, May 2008

12. MINDSET WHEN HOME Life is now unfocused and complex No longer on the verge of life or death What can replace the “high” of war? Things aren’t clear cut No sense of purpose, nothing matters Can’t trust anybody Can’t be in control of surroundings Problems at home pale in comparison to those in theater Adapted from briefing by COL Kevin Gerdes, May 2008

13. Mindset When Deployed vs. Mindset When Home SURVIVAL SKILLS WHILE DEPLOYED Buddies (cohesion) vs. Accountability vs. Targeted Agression vs. Tactical Awareness vs. Lethally Armed vs. Emotional Control vs. Mission OPSEC vs. Individual Responsibility vs. Non-Defensive Driving vs. Discipline and Ordering vs. HOME Withdrawal Controlling Inappropriate Aggression Hypervigilance “Locked and Loaded” @Home Anger/Detachment Secretiveness Guilt Aggressive Driving Conflict Battlemind.org

14. RESERVE & GUARD PERSONNEL Stress Following Deployment Return to civilian life Job may no longer be available May experience a reduction in income Transition of health care or loss of health coverage Loss of unit/military support system for the family Lack of follow up/observation by unit commanders to assess needs

15. OEF OIF OND PROGRAM OFFICE In early 2007 a directive was issued setting up a Program Manager and Transition Patient Advocate. Case Management positions were then separated from the Program Manager

16. Screenings: Traumatic Brain Injury PTSD Depression Substance Use Rabies Fevers Rashes Gastrointestinal Problems Embedded Fragments Military Sexual Trauma As Indicated: Suicide Risk Assessment Risk for Homelessness

17. SUBSTANCE USE PTSD DEPRESSION/SUICIDE ANXIETY/PANIC TBI PHYSICAL HEALTH CONCERNS RELATIONSHIP PROBLEMS

18. RISK FACTORS POST MILITARY DISCHARGE: ISOLATION RELATIONSHIP PROBLEMS UNEMPLOYMENT FINANCIAL PROBLEMS ADDICTION HOMELESSNESS DOMESTIC VIOLENCE LEGAL ISSUES INCARCERATION SUICIDE OTHERS

19. What have we learned? Veterans do not come home from war…. They come home with war. QUESTIONS

20. OEF OIF OND PROGRAM OFFICE OKC VA MEDICAL CENTER 405-456-3215 OR 405-456-1410