On April 30, 1975, ten Marines, the last Americans from the US embassy, departed Saigon, ending the United States presence in Vietnam. The final death toll from this war was approximately 58,000 soldiers; another 304,000 were wounded.1 Etched into the memories of most Americans old enough to remember the 1960s is the poor treatment given to returning Vietnam veterans by an unappreciative nation. When we should have shown our gratitude for their sacrifice, many Americans treated them as if by serving in this unpopular war, they had done something horribly wrong—or, even worse, as if they and the problems they came home with were invisible.
This national failure to honor our troops mirrored a shamefully inadequate response to their health care needs, especially the needs of those suffering from posttraumatic stress disorder (PTSD). If you were born before or too young to remember the Vietnam War and its tragic consequences, watch Born on the Fourth of July, the biography of Ron Kovic, a paralyzed veteran who felt betrayed by the country he fought for.2
Twenty-five years later, the United States is in the midst of another war—this time in Iraq. I'm not using this journal's bully pulpit to argue the pros and cons of our involvement in Iraq but rather to explore whether, as a nation, we are failing our veterans one more time. In a dramatic departure from how we responded to Vietnam veterans, today public support for our troops in Iraq is strong. The nation was therefore shocked when a February 2007 investigation by The Washington Post disclosed that wounded soldiers who were being treated as outpatients at Walter Reed Army Medical Center were living in dilapidated quarters and enduring long waits for treatment.3 What came with the improved survival rate for these wounded soldiers were frightful injuries that will require complicated and extended, sometimes lifelong care. For now, it's too soon to know how well those needs will be met.
I wanted to know what PAs might be seeing when the troops came home, and I learned that traumatic brain injury (TBI) had received considerable press. According to the Defense and Veterans Brain Injury Center (DVBIC), the US military formally diagnosed 2,121 cases of TBI between October 2001 and January 2007, many resulting from proximity to blast explosions.4 In fact, TBI has been called a signature injury of the conflict in Iraq.
The symptoms of TBI can range from mild to severe, depending on the extent of the damage to the brain. Patients with TBI can have headaches, memory loss, confusion, mood changes, lightheadedness, and seizures. A recent study in The New England Journal of Medicine found strong associations between mild TBI, PTSD, depression, and physical health problems in combat veterans.5
Major TBIs are certainly easy to detect; mild injuries are more elusive, however, making early identification and treatment crucial. PAs can take an important first step in screening for TBI by simply asking patients, “Are you a veteran, or is there a veteran in your family?”
To help providers obtain additional information, the DVBIC has developed an easy three-question screening tool to identify service members who might need further evaluation for mild TBI.6 The three questions are, “Did you have any injury during your deployment from any of the following?” Did any injury received while you were deployed result in any of the following?” “Are you currently experiencing any of the following problems that you think might be related to a possible head injury or concussion?” Each of the questions has 5 to 7 possible responses. I urge PAs to go to the DVBIC Web site and download this screening tool, while also keeping a high index of suspicion in their practice for identifying the patients they should be screening for TBI.
The AAPA demonstrated its strong support for veterans when the House of Delegates at the 36th Annual Physician Assistant Conference in San Antonio approved a resolution aimed at providing better care for war veterans and their families.7 Our profession, formed in the crucible of the Vietnam War, now has almost 2,000 PAs working in the VA system. We must join them, both as health care providers and as American citizens, in honoring our nation's heroes. They deserve nothing less.
5. Hoge CW, McGurk D, Thomas JL, et al. Mild traumatic brain injury in US soldiers returning from Iraq. N Engl J Med.