A Revised Clinical Approach to Current & Past Military Service Members’ HealthPopulation Health Clerkship – Fall 2016

Student Participants: Syed Haider Ali1, Micaela Cyr1, Max Kruse1, Liesl Matzka1, Grace McKay-Corkum1, Simon Ostrowski1, Max Pianka2, Inbar Yamin1

Faculty Leaders: Linda Cragin, Director MassAHEC Network1,2, Janet Hale PhD, RN, FNP, Professor and Associate Dean1,2, Tina Runyan, PhD, ABPP, Clinical Associate Professor1,2

1School of Medicine, 2Graduate School of Nursing

Yes

What do I ask now?When did you serve?

WWII (1941-1946)

Korea(1950-1953)

Vietnam(1964-1973)

Gulf War (1990-1991)

OIF/OEF/OND (2001 - present)

Cold Injury Experimental

chemical or nuclear exposure

PTS ALS

Cold Injury Experimental

chemical or nuclear exposure

PTS ALS

Agent Orange exposure

Hepatitis Substance abuse PTS ALS

Gulf War syndrome Oil well fires Chemical weapons

exposure Burn pit smoke PTS ALS

TBI Traumatic

Amputations Spinal Cord Injury Burn pit exposure PTS ALS

Has your service impacted you and your

family?

Are you connected to the VA?

Women Veterans’ Network

Veterans Inc.

Traumatic Brain Injury (TBI): Difficulties with sleeping, headache, impaired memory, and changes in mood. 19.5% of military service members report experiencing a TBI while deployed.

Post-Traumatic Stress (PTS): PTS onset can manifest soon after a traumatic event or delayed several months or years. Symptoms may be triggered by everyday experiences, such as fireworks, traffic, or dehydration. 10-18% of OEF/OIF troops experience PTS

Military Sexual Trauma (MST): 1 in 4 women and 1 in 100 men report experiencing MST during their service. Many do not report.

Substance Use Disorders: About 1 in 10 OEF/OIF veterans misuse drugs or alcohol. Veterans are twice as likely to die from accidental opioid overdoses than non-veterans.

Suicide: Risk for suicide is 21% higher for veterans compared to civilian adults.There are an estimated 22 veteran suicides per day

HAVE YOU OR A LOVED ONE SERVED IN THE MILITARY?

YESWhich branch did

you serve in?

What was your job in the military?

Veterans’ Health Administration Mass Vets Advisor Home Base

BATTLEMIND

The specific skills and mindset that enable soldiers to survive during combat

These skills often cause problems when the soldier returns home

SKILL In Combat At Home

Accountability Attention to detail and absolute control over weaponry/gear promotes survival

Anger when things are not in their 'proper' place

Awareness Survival depends on tactical awareness; being aware of surroundings at all times

Soldier is easily startledSoldier feels anxious in large groups, or when confined

Armed Carrying a weapon at all times is necessary and also mandated

Soldier feels the need to have weaponry on them at all times, to feel safe

Emotional control

Repressing emotions is needed to maintain tactical focus

Soldier feels 'numb'Soldier fails to display appropriate emotions, given social contextCan lead to relationship difficulties

SAVE teamVeterans’ Service Officers

http://download.militaryonesource.mil/12038/MOS/Reports/2014-Demographics-Report.pdf

Service Learning Project: State House Health FairMuch of the funding for veterans services comes from donations or federal funding. As part of our service project, we went to the state house to bring awareness for veterans services to legislatures and their staff for their continued support of these services.

Acknowledgements: Linda Cragin, MS, Director MassAHEC Network; Col. Janet Hale, PhD, RN,FNP, Assoc. Dean UMW-GSN, US Army Res. Ret.; Tina Runyan, PhD, ABPP, Assoc. Prof, DFMCH, USAF; Gen. Sean Collins (MA ANG), PhD, APRN-BC; Deborah DeMarco, MD, FACP; Bill Moore, President & CEO Project New Hope, USAF Ret.; Freedom, Therapy Dog; Beverly Franklin; Donna Scavone, APRN, BC; Lisa Dewar; David Smelson, PsyD, Dept of Psychiatry, National Center for Homelessness Among Veterans; Travis Bickford, Associate Dir. Military and Veterans Relations, William James College; Amber Hewitt, PsyD, DFMCH; Kristin M. Mattocks, PhD, MPH, Chief of Research, VA Central/Western MA; Molly Rivest, RN, DNP, USAF Ret., MST; Gabe Nutter, Cavalry Sergeant, US Army, MA Dept. of Veterans Services; Sammy, Therapy Dog; Ben Cluff, MPA, LADC1, CADC, Veterans’ Services Coord., MA DPH, USCG ret.; Cathryn Holzhauer, PhD; Barry N. Feldman, PhD (Dir. Psychiatry Programs in Public Safety, UMMS); Col. John Rodilico, PhD, ANG; Mike Spiros, RN, AGPCNP-BC, MALD, USN ret.; Col. Brent French, MBA, PhD (USAF Reserves); Tara Smallidge, Lieutenant Commander (sel) PhD, USN; CSM William Davidson, MA ARNG, Dir. Outreach & Support, Home Base; Laura Lakin, Home Base; Josh Egan, Home Base; Deb Hall, Lic Ac., Wellsprings Acupuncture; Northborough American Legion Post; Ed Bombard, USN; Al Graefing, US Army; Jerry Bourque, US Army; and Neil Swenor, USAF.

ReferencesBohnert ASB, Ilgen MA, Galeo S, et al. Accidental poisoning mortality among patients in the Department of Veteran Affairs health system. Med Care 2011;49:393-6.Critical Issues Facing Veterans and Military Families. http://www.samhsa.gov/veterans-military-families/critical-issues. Accessed October 27, 2016.Gulf War Veterans. http://www.benefits.va.gov/persona/veteran-gulfwar.asp. Accessed October 27, 2016.Injury Prevention & Control: Traumatic Brain Injury & Concussion. http://www.cdc.gov/traumaticbraininjury/index.html. Accessed October 27, 2016.Mental Health Effects of Serving in Afghanistan and Iraq. http://www.ptsd.va.gov/public/PTSD-overview/reintegration/overview-mental-health-effects.asp. Accessed October 27, 2016.Military Conflicts and Eras. http://www.mentalhealth.va.gov/communityproviders/docs/conflicts. Accessed October 27, 2016.Military Health History Pocket Card for Clinicians. http://www.va.gov/oaa/pocketcard/oefoif.asp?p=1. Accessed October 27, 2016.“Overview of Military Culture.” Jeanette Hsu. VA Palo Alto Health Care System; Sep 2010. Powerpoint.PDHRA Battlemind Training brochure. battlemind.org.Accessed October 27, 2016PTSD and Substance Abuse in Veterans. http://www.ptsd.va.gov/public/problems/ptsd_substance_abuse_veterans.asp Accessed October 27, 2016.Suicide Risk and Risk of Death Among Recent Veterans.http://www.publichealth.va.gov/epidemiology/studies/suicide-risk-death-risk-recent-veterans.asp. Accessed October 27, 2016.Tanielian, Terri, Lisa H. Jaycox, Terry L. Schell, Grant N. Marshall, M. Audrey Burnam, Christine Eibner, Benjamin R. Karney, Lisa S. Meredith, Jeanne S. Ringel and Mary E. Vaiana. Invisible Wounds: Mental Health and Cognitive Care Needs of America's Returning Veterans. Santa Monica, CA: RAND Corporation, 2008. http://www.rand.org/pubs/research_briefs/RB9336.htm