Air Force Symposium Highlights Today’s Research, Tomorrow’s Realities in Combat Casualty Care

U.S. Army photo by Spc. Terence Ewings

By Jayne Davis, DCoE Strategic Communications

“We Are Here to Generate Knowledge”

- Lt. Gen. Bruce Green, Air Force surgeon general

The 2011 Air Force Medical Service (AFMS) Research Symposium offered a record number of military and civilian medical service professionals, inroads and insights into advances in combat casualty care. About 400 medical professionals joined the three-day symposium, Aug. 2-4, 2011, at the Gaylord National Hotel and Convention Center in National Harbor, Md.

Plenary

“What we’re doing is pushing [beyond] the state of the art in military medical services; advancing combat casualty care in new ways and in new directions,” said Lt. Gen. Bruce Green, Air Force surgeon general, kicking off the first day’s multi-speaker plenary session.

Green described on-going innovative research in deployable medical assets. He spoke about convertible medical facilities for field operations; e-health advances, such as data technology that will allow patients to control their medical records; and antennae the size of a pinhead that can be embedded in band aid-type applications to transmit psychological markers.

“You represent the brain trust,” Green told the largely research-oriented audience. “[You’ll] create new realities, things no one else thought was possible.”

Air Force Reserve Col. Elizabeth Bridges, associate professor at the University of Washington, School of Nursing and a clinical nurse researcher at the university’s medical center, moved the conversation to trauma care and the continuum of care. In trauma care, Bridges implored researchers to apply two questions to their research: What is military relevant and what is military unique?

“We operate in the back of an air cargo plane at 30,000 feet,” said Bridges. “There are times service-specific questions need to be asked.”

In viewing combat casualty care as a continuum, Bridges emphasized the uncompromising standard of no decrease or degradation in the level of care throughout the entire process, from in-theater care to stateside rehabilitation. She also encouraged participants to share lessons learned from the day’s presentations.

Sharing lessons learned about psychological health and traumatic brain injury (TBI) captures the work of Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE), presented by Air Force Col. Christopher Robinson, DCoE deputy director for psychological health.

“In part, we translate research and put tools in the hands of health care providers so they can care for patients with psychological health concerns and TBI in the most effective way,” said Robinson.

Robinson described compelling data and evidence supporting the need to give these issues full attention, commenting that post-deployment PTSD and depression is far more reaching than the diagnosis of the individual; more attention is being paid to family adjustment issues.

“Military psychological health care is more than mental health care. It’s a command issue, a readiness issue, a community issue and a medical issue,” he said. Robinson talked about some of the lessons learned, such as the co-morbidity issues of post-traumatic stress disorder (PTSD), chronic pain and substance abuse.

“We now know these things are typically not isolated,” he said. He mentioned the importance of combat stress interventions even in very isolated places to help troops stay on track. And he acknowledged the reserve components as vulnerable populations, when considering psychological health care, in that they don’t always have the base support that active-duty service members have.

Robinson went on to discuss leadership involvement like commanders being able to identify certain markers of TBI that should be of concern: poor marksmanship, slower reaction time and decreased concentration.

Turning back to tools DCoE offers to health care providers, Robinson mentioned some of DCoE’s numerous resources, beginning with the Real Warriors Campaign.

“If you want to provide compelling testimony of folks who said they had these difficulties, sought treatment and got better, go to the Real Warriors website,” he told the audience. He identified the 24/7 DCoE Outreach Center for expertise on psychological health and TBI by phone, email or live chat as another critical resource, along with new mobile applications for stress reduction and TBI care, such as the PTSD Coach app.

“Use your smartphone to download the Mild TBI Pocket Guide mobile app,” he advised the audience. “It needs to get in the hands of all providers as it gives you everything you need to know about TBI and interventions.”

Of the Co-occurring Conditions Toolkit: Mild Traumatic Brain Injury (TBI) and Psychological Health, which helps providers assess and manage patients with co-occurring mild TBI and psychological health concerns, Robinson said providers find the medication chart especially helpful. The toolkit and a new video explaining how to apply the toolkit to clinical practice can be ordered free from the Defense and Veterans Brain Injury Center at info@dvbic.org.

Medal of Honor recipient, Army Capt. Paul Bucha, brought the first day’s morning session to a close with a lively and emotional review of his five elements of leadership, addressing the crowd as leaders in the field of military medical services.

Break-Out Sessions

Five parallel scientific tracks covering operational medicine, en-route care and expeditionary medicine, force health protection, TBI and psychological health, and health care information science offered attendees choices for the afternoon breakout sessions throughout the event.

Highlights from the TBI and psychological health track on day one included a pro and con discussion about the interpretation of recently published international research findings on decompressive craniectomy, a controversial neurosurgical procedure where part of the skull is removed to allow a swelling brain room to expand, for patients with severe brain injuries from blast trauma. Led by Dr. Kenneth Curley, neurotrauma portfolio manager for U.S. Army Medical Research and Materiel Command, four prominent neurosurgeons debated the highly-controversial research. The informative debate brought attention to the fact that decisions of if and when to perform the procedure, in the context of TBI, are often matters of life and death.

Dr. Vladimir Nacev, clinical psychologist with DCoE Resilience and Prevention directorate, presented on post-deployment adjustment problems, with a focus on substance abuse. Echoing Robinson’s concern about reserve component members, Nacev noted that these populations have higher percentages of psychological concerns following their deployments than active-duty service members. Other findings he shared on deployment and psychological health:

• Service members with PTSD and depression have increased likelihood of new onset of heavy drinking, binge drinking and continued alcohol-related problems
• Many psychological concerns surface much later than earlier thought
• Those deployed three to four times have increased risk of behavioral problems, specifically with alcohol

Nacev encouraged his audience to explore information and resources at Real Warriors Campaign, and offered this closing thought: “I foresee the next substance abuse problem for the military being prescription drugs. We have a large number of people with physical injuries who become addicted to painkillers because of operational tempo. We need to ask questions about prescription misuse during pre- and post-deployment screening.”

Continuing the theme of deployment-related issues, Air Force Maj. Rachel Foster, Air Force Medical Operations Agency, revealed that rates of spouse abuse among married, active-duty Air Force personnel were lower after deployment than before deployment in contrast to expectations. The findings were from the first population-based investigation. She added the caveat that because spouse abuse rates did increase following deployment under certain circumstances, efforts should focus on context and in particular, the use of alcohol.

Poster Series

Capping off the first day, a poster session magnifying 53 scientific abstracts gave symposium participants an enlightening view of medical services trends and analyses. Dr. James Bender, DCoE psychologist, presented a poster entitled, “The Effects of Sympathetic Nervous System Activation on Brain and Behavior,” and had this to say of the symposium: “It was great to see so many informed military people getting together to share ideas and the latest information on patient care, health science, and force protection. I'm glad that DCoE was able to contribute.”

Read the story on day two of the AFMS Research Symposium.