WHEN WAR COMES HOME

THE IMPACT ON OKLAHOMA

COMMUNITIES

Analysis of VA Health Care Utilization among Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) Veterans.Cumulative from 1st Qtr FY 2002 through 2nd 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 updates

October 1, 2001- March 31, 2014 5,851

have died in-theater.

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

1,791,420

OEF, OIF, OND veterans have left active duty since FY 2002

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

Now or Later Video

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

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

Stressors in the Deployment Cycle

Pre-deploymentNotificationPreparation

Training

Return from DeploymentReunion

Reintegration

DeploymentDeparture

SustainmentCombat and

conflict

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

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

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.

HOMEWithdrawalControllingInappropriate AggressionHypervigilance“Locked and Loaded” @HomeAnger/DetachmentSecretivenessGuiltAggressive DrivingConflict

Battlemind.org

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

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

Screenings:Traumatic Brain InjuryPTSDDepressionSubstance UseRabiesFeversRashesGastrointestinal ProblemsEmbedded FragmentsMilitary Sexual Trauma

As Indicated:Suicide Risk AssessmentRisk for Homelessness

SUBSTANCE USEPTSD

DEPRESSION/SUICIDE

ANXIETY/PANIC

TBI PHYSICAL HEALTH

CONCERNS

RELATIONSHIP PROBLEMS

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

What have we learned?

Veterans do not come home from war….

They come home with war.

QUESTIONS

OEF OIF OND PROGRAM OFFICEOKC VA MEDICAL CENTER

405-456-3215 OR 405-456-1410