Treats all patients evacuated from both combat theaters

Treats all patients evacuated from both combat theaters

• Treats all patients evacuated from both combat theaters

• The only ACS trauma center outside the US

• 65,000 patients evacuated from U.S. CENTCOM (from 45 coalition nations)

• 12,000 combat casualties (2004-2010)

• Responsible for treatment of 245,000 U.S. military personnel and families within Europe

Fully accredited (JCAHO, ACS, etc)

• Fully accredited (JCAHO, ACS, etc)

• Staffing: 2,837 including 1,161 Army, 309 Air Force, 304 Navy, 12 Marines, 1,279 civilians and 4 VA civilians

• 149 inpatient beds

• 218 beds in its Medical Transient Detachment

Oct –Dec 2003 at LRMC

• Oct –Dec 2003 at LRMC

• Mar- May 2006 at LRMC

• Mar- May 2008 at Vilseck : working with families and with the WTU (Warrior Transition Unit)

Priority #1: OIF/OEF patients with blast injuries.

• Priority #1: OIF/OEF patients with blast injuries.

• Priority #2: OIF/OEF patients with non-blast injuries.

• Goal: Every patient receives a triage assessment and psychological first aid.

Introduction “I’m a psychiatrist working with your medical team. Every patient gets ‘top to bottom care.’”

• Introduction “I’m a psychiatrist working with your medical team. Every patient gets ‘top to bottom care.’”

• Pain assessment

• 1) pain level using the pain scale 1-10.
• 2) “At what level do you call the nurse for help?”
• 3) Catching the pain early can reduce the amount of pain medication required.

Room temperature

• Room temperature

• Hydration

• Nutrition

• Sunlight

• Privacy

Knowledge of medical information

• Knowledge of medical information

• The trauma story.

• Filling in the missing pieces.
• Post trauma symptom assessment.
• PTSD education

Quantity and quality of:

• Quantity and quality of:

• IED attacks
• Small arms fire
• Mortar attacks
• Suicide bombers
• Exposure to dead bodies
• Returning fire

Normalize the response to trauma as universal, using the metaphor of tissue injury.

• Normalize the response to trauma as universal, using the metaphor of tissue injury.

• Healing of the mind requires a mastery of the event.

• Dreams, flashbacks, emotional flooding are normal psychological reactions to trauma.

A common reaction to trauma especially if others have been killed or wounded.

• A common reaction to trauma especially if others have been killed or wounded.

• The belief they have let their unit down.

• Treatment approach includes getting the facts of the incident, reviewing their role and response, arranging communication with unit downrange.

• After Action Report model

A common anxiety is when they will fly and where they will be transferred to.

• A common anxiety is when they will fly and where they will be transferred to.

• Reinforce soldier’s ability to communicate needs (pain, comfort, anxiety, etc.)

• Follow up e-mail or phone call to CONUS for those patients demonstrating Acute Stress Disorder symptoms.