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PrintQ: Post-traumatic shock doesn’t just affect the person who suffers from it. Its impact reverberates on family, community, and society. What are some of effects?
A: These are the areas where people have barely begun to put a price tag on. Divorce, unemployment, family, violence, behavioral problems in children, homelessness, incarceration—all of those things are features that are associated with PTSD—depression and suicide as well. It’s something that tears families apart and destroy marriages. In clinical practice, that is what I see—people who are losing their marriages and who are very detached from their families.
Q: To switch to the physical damage we’re seeing, I guess that term that has emerged is “polytrauma.” What is that?
A: It’s kind of a chilling word in how sanitized the word is. It refers to multiple severe injuries. The essential dynamic is that you’ve got these explosions—blast injuries are the large majority of injuries. You have a combination of the advances on our side in the body armor—we arm our vehicles and we have this Kevlar body armor that basically protects the torso. What’s happening on the insurgent side is that they are coming up with greater and greater explosive forces in the devices they are producing. You have the body armor and the increased explosive force and you get the limbs and the head are vulnerable. The helmet may protect you from projectiles, but there’s a blast wave injury that’s essentially due to atmospheric pressure changes that’s not very well understood at this point and time—what a blast wave does to the brain. So you see amputation, fractures, burns, blindness and brain injury and spinal cord injury. Often people will have multiple injuries and the percentage of injured that have amputations is the highest rate we’ve seen since the US Civil War.
Q: The report noted there was a 2:1 ratio of injuries to death in World War II and an 8:1 ratio in Iraq. Is part of what’s driving costs the fact that we’re doing a better job of keeping people alive?
A: There have been great advances in battlefield medicine. We can get in there and set up these incredible, capable surgical field tents in theater. They stabilize people, pack the wounds, and get them out. There’s this wonderful facility at the Landstuhl Air Force Base in Germany. They stabilize people with often horrible wounds and get them out to this first rate facility in Germany within 24 hours. They are able to save people that would never have lived previously. The medicine advances are really tremendous. Many individuals are surviving with injuries they would have died from in previous conflicts and these are going to be very costly to take care of. There’s going to be hundreds and thousands of these people who require daily care and very expensive prosthetic devices.
Q: Are we prepared for what’s coming?
A: That’s the question. I don’t think whether or not we care for our veterans is a valid question. What kind of country would we be if we didn’t care for our veterans? There just has not been enough consideration about the price we’re going to pay. Not only the price we’re paying, but the price we are consigning our children and grandchildren to pay, because these are long-term cost over the lifetime for people with physical and mental injuries, in additions to all of the social ills that the society will be paying for a long period of time. I’m proud to work for the VA system and I think, at least on the healthcare side, if the VA is given the resource that it needs, it can take pretty good care of its veterans. It’s only a question of whether we can afford those resources and whether we’re really prepared for this influx of veterans that we’re going to need to take care of. The system was already strained before we talk about the new veterans. We’re still paying for all the consequences of the previous wars.
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