1. Joining Forces Initiative Traumatic Brain Injury Post Traumatic Stress Syndrome Michael K Murphy, DO FACOFP, dist, FAODME DME, Bluefield Regional Medical Center CAPT MC USN (ret)

2. Joining Forces

3. For this newest generation of American veterans and their families, PTSD, TBI, and post-combat depression have become the signature wounds of our latest conflicts.For this newest generation of American veterans and their families, PTSD, TBI, and post-combat depression have become the signature wounds of our latest conflicts. –First Lady Michelle Obama–First Lady Michelle Obama

4. Joining Forces Weve got to make sure that no matter where they seek help, our veterans and military families get care thats worthy of their service. They deserve doctors who understand military culture and the challenges that come along with a life in our Armed Forces. They deserve nurses, social workers, and counselors who have access to the most cutting-edge research and techniques for diagnosis and care. And they deserve a health care system that fully understands these issues and is focused on solving them.–First Lady Michelle ObamaWeve got to make sure that no matter where they seek help, our veterans and military families get care thats worthy of their service. They deserve doctors who understand military culture and the challenges that come along with a life in our Armed Forces. They deserve nurses, social workers, and counselors who have access to the most cutting-edge research and techniques for diagnosis and care. And they deserve a health care system that fully understands these issues and is focused on solving them. –First Lady Michelle Obama

5. Joining Forces We know that one of the biggest challenges our troops and their families will face is mental health challenges – the unseen wounds of war. These challenges put a strain on marriages, family relationships, even friendships. Spouses can feel isolated and lonely. Kids might act out. It used to be that no one talked about these issues. But thats why were here today – because each one of us is in a position to help. We know that one of the biggest challenges our troops and their families will face is mental health challenges – the unseen wounds of war. These challenges put a strain on marriages, family relationships, even friendships. Spouses can feel isolated and lonely. Kids might act out. It used to be that no one talked about these issues. But thats why were here today – because each one of us is in a position to help. –Brad Cooper, Executive Director of Joining Forces –Brad Cooper, Executive Director of Joining Forces

6. Joining Forces Accreditation Council for Graduate Medical Education (ACGME)Accreditation Council for Graduate Medical Education (ACGME) American Association of Colleges of Osteopathic Medicine (AACOM)American Association of Colleges of Osteopathic Medicine (AACOM) Association of Academic Health CentersAssociation of Academic Health Centers Association of American Medical CollegesAssociation of American Medical Colleges Council on Social Work EducationCouncil on Social Work Education National Board for Certified CounselorsNational Board for Certified Counselors National Board of Medical ExaminersNational Board of Medical Examiners Physician Assistant Education AssociationPhysician Assistant Education Association

7. Joining Forces American Academy of Family PhysiciansAmerican Academy of Family Physicians American Academy of Nurse PractitionersAmerican Academy of Nurse Practitioners American Academy of PediatricsAmerican Academy of Pediatrics American Academy of Physician AssistantsAmerican Academy of Physician Assistants American College of PhysiciansAmerican College of Physicians American Medical Association AMAAmerican Medical Association AMA American Nurses AssociationAmerican Nurses Association American Osteopathic Association (AOA)American Osteopathic Association (AOA) American Psychiatric AssociationAmerican Psychiatric Association MedscapeMedscape

8. Joining Forces American Academy of Physical Medicine and RehabilitationAmerican Academy of Physical Medicine and Rehabilitation American Academy of NeurologyAmerican Academy of Neurology American Academy of Pain MedicineAmerican Academy of Pain Medicine American College of Emergency PhysiciansAmerican College of Emergency Physicians American College of SurgeonsAmerican College of Surgeons American Congress of Obstetricians and GynecologistsAmerican Congress of Obstetricians and Gynecologists Citizen Soldier Support ProgramCitizen Soldier Support Program National Association of Social WorkersNational Association of Social Workers

9. Joining Forces American Association of Oral and Maxillofacial SurgeonsAmerican Association of Oral and Maxillofacial Surgeons American Association for Marriage and Family TherapyAmerican Association for Marriage and Family Therapy American Dental AssociationAmerican Dental Association American Physical Therapy AssociationAmerican Physical Therapy Association American Psychiatric Institute for Research & EducationAmerican Psychiatric Institute for Research & Education American Psychological AssociationAmerican Psychological Association National Area Health Education Center OrganizationNational Area Health Education Center Organization National Association of Community Health CentersNational Association of Community Health Centers

10. TBI and PTSD Objectives Understand the Joining Forces initiativeUnderstand the Joining Forces initiative –Be familiar with the resources available Be familiar with theBe familiar with the –definition for TBI –Symptoms of TBI –Treatment of TBI Be familiar with theBe familiar with the –definition for PTSD –Symptoms of PTSD –Treatment of PTSD

11. TBI and PTSD To understand the injured warrior you must understand the warrior culture To understand the injured warrior you must understand the warrior culture Special Assistant to the Chairman of the Joint Chiefs of Staff

16. TBI and PTSD Warrior Ethos I will always place the mission first.I will always place the mission first. I will never accept defeat.I will never accept defeat. I will never quit.I will never quit. I will never leave a fallen comrade.I will never leave a fallen comrade.

17. TBI and PTSD Factoids 2.0 million men and women have served in the two war zones2.0 million men and women have served in the two war zones 10-17% have experienced situations or injuries that could result in TBI/PTSD10-17% have experienced situations or injuries that could result in TBI/PTSD 50% are not reported50% are not reported >50% are treated in their communities>50% are treated in their communities TBI and PTSD are considered the silent injuries of warTBI and PTSD are considered the silent injuries of war

18. TBI and PTSD Factoids Since Sept.11, 2001, more than 2 million U.S. troops have been deployed to Iraq and Afghanistan. About 40% of current military service members have been deployed more than once.Since Sept.11, 2001, more than 2 million U.S. troops have been deployed to Iraq and Afghanistan. About 40% of current military service members have been deployed more than once. There are 1.4 million active duty service members14% of whom are womenand 1.1 million Guard and Reserve members.There are 1.4 million active duty service members14% of whom are womenand 1.1 million Guard and Reserve members. –There are 2.0 million spouses and children/dependents of active duty service members. –44% of active duty service members have children76% of these children are age 11 and younger. –Only 37% of families live on military installations; the remaining 63% live in over 4,000 communities nationwide. Strengthening Our Military Families: Meeting Americas Commitment January 2011 Demographics 2010: Profile of the Military Community

19. TBI and PTSD Factoids With the end of the war in Iraq and the drawdown in Afghanistan, over 1 million service members are projected to leave the military between 2011 and 2016.With the end of the war in Iraq and the drawdown in Afghanistan, over 1 million service members are projected to leave the military between 2011 and 2016. There are an estimated 22.2 million Veterans in the U.S.8% of whom are women.There are an estimated 22.2 million Veterans in the U.S.8% of whom are women. National Center for Veterans Analysis and Statistics, Veteran Population Projection Model (VetPop) 2007 National Center for Veterans Analysis and Statistics, Veteran Population Projection Model (VetPop) 2007

20. TBI and PTSD Factoids In the current conflicts, the military has experienced multiple re-deployments; short dwell time between deployments; greater dependence on the National Guard and reserve components; deployment of high numbers of women and parents of young children; and a higher number of service members who survive serious injuries that in previous wars would have been fatal.[i]In the current conflicts, the military has experienced multiple re-deployments; short dwell time between deployments; greater dependence on the National Guard and reserve components; deployment of high numbers of women and parents of young children; and a higher number of service members who survive serious injuries that in previous wars would have been fatal.[i][i] The majority of returning service members and their families are resilient to the stresses of war and successfully re-adjust to life after deployment.The majority of returning service members and their families are resilient to the stresses of war and successfully re-adjust to life after deployment. [i][i] Returning Home from Iraq and Afghanistan: preliminary assessment of readjustment needs of veterans, service members and their families. 2010. Institute of Medicine [i]

21. TBI and PTSD Factoids About one in three U.S. service members returning from Iraq or Afghanistan experiences signs of combat stress, depression, post traumatic stress disorder (PTSD) or symptoms of a traumatic brain injury (TBI).About one in three U.S. service members returning from Iraq or Afghanistan experiences signs of combat stress, depression, post traumatic stress disorder (PTSD) or symptoms of a traumatic brain injury (TBI). Only 53% of returning troops who screened positive for PTSD or major depression sought help from a provider for these conditions in the preceding year.Only 53% of returning troops who screened positive for PTSD or major depression sought help from a provider for these conditions in the preceding year. Of those who had PTSD or depression and sought treatment, only slightly over half received adequate treatment.Of those who had PTSD or depression and sought treatment, only slightly over half received adequate treatment. Tanielian, T. L., RAND Corporation & Center for Military Health Policy Research. (2008). Invisible wounds of war: Psychological and cognitive injuries, their consequences, and services to assist recovery.

22. TBI and PTSD Factoids Only 57% of those with a probable TBI had been evaluated by a physician for a brain injury in the preceding year.Only 57% of those with a probable TBI had been evaluated by a physician for a brain injury in the preceding year. Although 53% of recent Iraq and Afghanistan Veterans receive their health care through the VA, many Veterans and their families will seek care in community settings from primary care and community mental health clinicians.Although 53% of recent Iraq and Afghanistan Veterans receive their health care through the VA, many Veterans and their families will seek care in community settings from primary care and community mental health clinicians. National Center for PTSD. Mental health effects of serving in Afghanistan and Iraq. http://www.ptsd.va.gov/public/pages/overview-mental-health-effects.asp

23. TBI and PTSD Factoids Of recent Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans who used VA care, 48% were diagnosed with a mental health problem.Of recent Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans who used VA care, 48% were diagnosed with a mental health problem. In the five years from 2005 to 2010, on average, one service member committed suicide every 36 hours.In the five years from 2005 to 2010, on average, one service member committed suicide every 36 hours. Losing the Battle: the challenge of military suicide. Center for a New American Security. October 2011 Losing the Battle: the challenge of military suicide. Center for a New American Security. October 2011

24. TBI and PTSD Factoids U.S. Army suicides reached an all-time high in July 2011 with the deaths of 33 active and reserve component service members.U.S. Army suicides reached an all-time high in July 2011 with the deaths of 33 active and reserve component service members. Mental and substance use disorders caused more hospitalizations among U.S. troops in 2009 than any other cause.Mental and substance use disorders caused more hospitalizations among U.S. troops in 2009 than any other cause. Children of deployed military personnel have more school, family and peer-related emotional difficulties, compared with national samples.Children of deployed military personnel have more school, family and peer-related emotional difficulties, compared with national samples. Zoroya, G. (2010, May 14). Mental health hospitalizations up for troops. USA Today. (Original source: Pentagons Medical Surveillance Month Report.) Chandra, A., Lara-Cinisomo, S., Jaycox, L. H., et al. (2010). Children on the homefront: The experience of children from military families. Pediatrics, 125, 16–25.

25. TBI and PTSD Factoids 2.3 million men and women have served in the two war zones2.3 million men and women have served in the two war zones 10-17% have experienced situations or injuries that could result in TBI/PTSD10-17% have experienced situations or injuries that could result in TBI/PTSD 50% are not reported50% are not reported >50% are treated in their communities>50% are treated in their communities TBI and PTSD are considered the silent injuries of warTBI and PTSD are considered the silent injuries of war

26. TBI and PTSD

27. Military Health History Tell me about your military experience.Tell me about your military experience. When and where do or did you serve?When and where do or did you serve? What do or did you do while in the service?What do or did you do while in the service? How has military service affected you?How has military service affected you?

28. TBI and PTSD Military Health History POSITIVE Did you see combat, enemy fire or casualties?Did you see combat, enemy fire or casualties? Were you wounded, injured or hospitalized?Were you wounded, injured or hospitalized? Did you ever become ill while you were in the service?Did you ever become ill while you were in the service? Were you a prisoner of war?Were you a prisoner of war?

29. TBI and PTSD There is still a stigma associated with TBI and PTSD. There is still a stigma associated with TBI and PTSD. Many veterans and active duty attempt to work through this or to seek care outside the system to avoid this. Many veterans and active duty attempt to work through this or to seek care outside the system to avoid this.

30. Lt Cmdr Richard Jadick, DO, MC, USN

34. Joining Forces Initiative Traumatic Brain Injury Post Traumatic Stress Syndrome Michael K Murphy, DO FACOFP, dist, FAODME DME, Bluefield Regional Medical Center CAPT MC USN (ret)