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Patient Care

When Veterans Become Victims

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A decade-plus of war will take its toll. Around 2.5 million Americans have now served in Afghanistan and Iraq. Many have come home with problems, and more will. 

As those in the emergency services often witness, veterans can endure aftereffects of service that affect their behavior. Post-traumatic stress can leave sufferers irritable, jumpy and prone to unwanted memories. Traumatic brain injury, the “signature” injury of recent conflicts, can trigger mood swings, depression, anxiety and outbursts. Both can lead to social problems like domestic conflict, alcohol/drug abuse and homelessness. Last year, per the Department of Veterans Affairs, almost 50,000 veterans of those wars were homeless or at risk of it. 

With such afflictions, troubled vets can easily come into contact with 9-1-1 systems. To provide them appropriate care and help avert negative and potentially tragic outcomes, responders should understand their unique needs. 

“We ask these young people to go protect our country and be in harm’s way. To me, the least we can do is to provide them the services they need when they come back,” says John Gallagher, MD, EMS medical director for the Phoenix Fire Department. “That’s something every American should be committed to.”

Phoenix Fire has put that belief into practice with a special veteran awareness training program for its providers and public-safety colleagues. The goal is to orient responders to the challenges veterans can face and give them tools to help those vets get assistance.

“I felt like we weren’t really understanding the things that can happen,” says Gallagher. “These guys have had TBIs, concussions, they can have difficulty with depression. In 2009 there were more military suicides than combat deaths in Iraq and Afghanistan combined. How are we letting that happen?! We owe these people more than that when they get home.” 

Frontline on the Homefront

The Phoenix effort was orchestrated by Capt. Dean Pedrotti, who’d become alarmed by the numbers of veterans ending up among the local homeless. He worked with the Arizona Coalition for Military Families and Arizona National Guard to develop a three-hour training for department paramedics, which was delivered in 2012. A highlight of that was a trio of actual wounded vets telling their stories. 

“It was jaw-dropping,” says Pedrotti. “Hearing the personal stories changes everything. I had people tell me, ‘Dean, that was the best CE I’ve attended in 25 years on the job.’” 

The program was such a hit that Chief Bob Khan had it taken department-wide. It also spread beyond PFD to other local entities and caregivers, including hospital physicians, nurses, behavioral health and clergy—potential responders all when a vet’s in crisis. Now, two years later, some 3,000–3,500 area responders have received it. 

Titled “Frontline on the Homefront: Military Veterans in Crisis,” the three-part program orients providers to military culture and outlines the major stressors personnel face while serving. It looks at the numbers and potential growth of related problems in coming years. It delves into the symptoms and manifestations of PTSD and TBI and provides clues to look for and tips for dealing with sufferers, and offers resources for troubled vets and their families. 

The department supplements this with a mobile crisis van, staffed with an EMT and social-work grad student, that can be dispatched 24/7. The goal is to assist vets’ problem of the moment and get them connected to help for whatever underlies it (homelessness, alcohol, etc.). At the same time Phoenix has worked aggressively to house its homeless vets, and in January the White House recognized the city as the first to achieve full housing of all its identified local homeless veterans. 

‘That Push They Need’

The training paid off quickly. Early in the program, Pedrotti says, a young man in a Phoenix suburb was being arrested as drunk and disorderly. Uncooperative with officers, he threatened to harm them and himself. He mentioned an extreme headache. Then an astute fire-company engineer caught a fleeting military reference. 

The engineer inquired and discovered the young man was an active-duty airman, assigned locally. He’d had the headache for a while but not sought help because he was embarrassed by its cause (a sporting mishap). Instead he’d been self-medicating with booze. 

The crew realized the possibility of an undiagnosed TBI. And with the alertness of the engineer, the patient ended up in a hospital for it that night, rather than jail. 

“We’ve seen people, just by the front-end awareness, change how they treat patients,” says Pedrotti. “They’re better equipped to coordinate and get them to the right resources.” 

This year the training is being adapted for Phoenix police, and the department invites others in fire and EMS to review it also. Find its three modules under the ‘Situation Awareness’ tab at http://phoenixfireops.com/ctc/situation-awareness/. A few condensed tips and best practices accompany this article. 

“We tell crews to get in there, talk to these folks, find out where they’re at and what’s causing their stress level today,” Pedrotti says. “Just talking to them the right way is like giving a chest pain patient nitro: It drops their stress. Then it’s a matter of getting them dialed in to additional services. 

“We find that veterans are very closely associated with first responders; often they know a couple. So our telling them, ‘Hey, I really think you should get a little help’ might be that push they need to follow up.” 

 

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