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