Archive for category Medical

Publications: RAND–Out Of The Shadows, A Survey On Contractor Health

Awhile back I was contacted by RAND to help promote this survey. I agreed because there was not enough information out there on the subject of contractor physical and mental health in these wars. So it is cool to see a final product and available for folks to check out.

The information provided is pretty revealing and I highly suggest reviewing the document if you are interested in either getting into this industry, or just learning about the actual health of this industry.

Now for some of the interesting tidbits that I found in the survey.

Only 16 percent of contractors sampled had ever made a DBA claim. Among those whose most recent contract had been funded by the U.S. government, 22 percent reported that they had made a DBA claim. The DBA mandates that all civilian employees working outside the United States on U.S. military bases or under a contract with the U.S. government for public works or national defense have access to workers’ compensation for injuries or deaths sustained as a result of such employment. We found that, among respondents who applied for benefits, 57 percent of claims were approved and 37 percent were either denied or still being processed at the time of the survey. (Six percent of respondents reported that they did not know the outcome of their DBA claim.) Contractors from the United States were more likely to file DBA claims than those from other countries. -page 20

Only 57 percent approved?  This is a horrible statistic, but not new. The survey mentioned the findings of T. Christian Miller’s report as well, which I posted several years back.

In a series of articles for ProPublica, T. Christian Miller reported on the types of physical and mental health problems affecting contractors, including loss of limbs,burns, loss of hearing or eyesight, various wounds (such as from shrapnel, gunshots, mortar attacks, or IEDs), PTSD, TBI, depression, suicidal ideation, and suicide. Despite the reported frequency and severity of these problems, Miller (2009a) found that between 2002 and 2007, “insurers had denied 44 percent of all serious injury claims” under the DBA and that they “also turned down 60 percent of contractors who claimed to suffer psychological damage, such as post-traumatic stress disorder.” He highlights systemic flaws in the DBA—along with a lack of regulation and enforcement by the U.S. Department of Labor and the monopoly of insurance company AIG—as contributors to the high rate of DBA claim denial.

 It just blows me away that ’60 percent of contractors’ with PTSD or some mental health issue, were turned down! And according to this recent survey, only 57 of these folks surveyed had that had DBA claims, had them approved. That has to change and contractors have sacrificed in this war. They deserve better than that, and it is shameful contractors are treated like this.

They also mentioned a company that specializes in providing mental health services. Back in 2008, I wrote a brief deal about Mission Critical Psychological Services and it is good to see they are still doing their thing.

Individual private companies have also developed programs to address the psychological challenges facing contractors, though there is limited publicly available information on how these programs are structured or the types of support they offer. For example, Mission Critical Psychological Services is a U.S.-based firm that provides psychological support services to firms in the contracting industry. Asked to estimate the number of contractors suffering from mental health issues, its CEO stated, “I think the numbers are in the thousands, maybe tens of thousands. Many are going undiagnosed. These guys are fighting demons, and they don’t know how to cope” (Risen, 2007). -page 45

I hope to see more companies pop up to meet the demand of contractor mental health, and especially after reports like this bringing attention to the matter. Or maybe, PMSC’s will be more focused on paying attention to this. Especially when they get their various certifications that show how compliant they are or when they are signatories to things like the ICoC. Check this quote out.

The extent to which the diverse array of contracting companies rely on private providers of psychological services tailored to the industry is unclear. However, recent U.S. and international codes and standards aimed at regulating the private security industry, in particular, clearly mandate that these firms establish policies that promote a safe and healthy working environment, including policies that address the psychological health of employees. One such requirement is embedded in the American National Standards Institute/ASIS International document Management System for Quality of Private Security Company Operations (known as the PSC.1 standard), which states, “The organization shall establish, implement, and maintain procedures to promote a safe and healthy working environment including reasonable precautions to protect people working on its behalf in high-risk or life threatening operations consistent with legal, regulatory, and contractual obligations.” One of the procedures specified is “medical and psychological health awareness training, care, and support” (American National Standards Institute and ASIS International, 2012,p. 24). The inclusion of such a requirement in the PSC.1 standard is significant, because compliance with the standard is now mandated in all DoD- and UK government-funded contracts. Moreover, the International Code of Conduct, a multi-stakeholder initiative aimed at industry self-regulation to which more than 600 private security companies are now signatories, includes a similar provision requiring that signatory companies adopt policies that support a safe and healthy working environment. This requirement specifically mentions a requirement for policies that address psychological health (“International Code of Conduct for Private Security Service Providers,” 2010,section 64d, p. 14). -page 45

Why is this important? Well for one, if you look at past incidents of contractors ‘snapping’ like with the Fitzsimmons case in Iraq, you can see why it is so important for companies to care about this stuff. Unfortunately, they do not care.

It is my experience as a contractor that none of the companies I have worked for, presented any kind of program that focused on the mental health of it’s contractors. I was never informed of any services and was just expected to deal with issues on my own.

Nor have I have ever worked with anyone in the past that has filed a DBA as a contractor for mental health issues–even though I know there are guys who should. Hell, this year alone, I am aware of two contractors that I worked with in the past that committed suicide recently–one of which was a friend. So I know there are mental issues out there, and yet the companies are not really getting involved with this stuff.

The report also mentioned the fact that many contractors are prior veterans and may have gotten their PTSD from service in the military, which I concur. So with that said, the VA should be highly responsive to the needs of these veterans. Should, is the key word, because you get an earful from guys on contract on how crappy the VA is when dealing with this stuff.  Several issues I have seen with contractors whom are veterans, are sleeping issues and TBI or traumatic brain injury. Or the use of pain killers to deal with past injuries. As for mental stuff, it is there, but guys usually don’t like going there.

On the positive side, contracts are a great way for veterans to come together again and share experiences. This is called armed group therapy. lol. Many contractors are attracted to this type of work, because it gets them back in the game of war, and gets them amongst a group that understands war. It is hard for guys to relate to others whom have not experienced that stuff, so that is what makes contracting a plus for veterans.

It is also interesting to note that if you watch AFN (Armed Forces Network) commercials overseas on TV, you are constantly bombarded by deals about suicide in the military or PTSD in the military. The services are constantly trying to reach out to Joes, and work the problem of suicide and PTSD. There are no commercials reaching out to contractors with similar health issues–even though there are more contractors in the war zones than there are military folks. There are no commercials at all geared towards contractors, which is interesting. With such health issues identified by RAND and others, some kind of effort to reach out to contractors could save lives.

Some other factoids that were of interest to me were the combat experiences and living conditions of contractors overseas. The one group of contractors that saw the most combat in this survey were the transportation security contractors or PSD/Convoy guys. The folks that go outside the wire and are exposed to the same dangers as the military, who all have to travel the same roads.

Training and advising contractors were the second most dangerous, which makes sense with all of the green on blue incidents involving contractors happening in places like Afghanistan. Also, by nationality in this survey, the US contractors saw more combat than any other nationality surveyed. Although I doubt this would be the case if Afghan or Iraqi contractors were more involved in this survey. lol

The living conditions of contractors were interesting as well. The worst living conditions experienced were the transportation guys. Living in transient tents all the time or sleeping in your truck can get old. You also work really long hours and the whole 12 hour shift concept seems to be used more and more by companies. Which really sucks, because this hinders sleep, thus making it difficult to keep sharp on the job. More companies neglect giving time off out in the field as well, and there is not enough emphasis on giving folks a break out there so they can recharge. Getting good sleep and not being overworked is crucial to security operations, and this is neglected all the time by the companies.

The best living conditions were experienced by the maritime security folks and logistics/maintenance folks.

Interesting report and check it out for yourself. Companies should take the time to read this and get a better feel for what is going on out there with their people, or try to work harder to meet the needs of their people. Thanks to RAND and authors, and to all of the contractors that participated in this survey. Hopefully this will get the conversation going on the true health of this industry, and how to meet the needs of contractors. -Matt

 

 

Read the report here.

Read the summary here.

This is a quick report done on AIG and the way they have treated DBA claims of contractors. Horrible treatment is all I have to say, and the statistics support that.

 

Contractors Who Worked in Conflict Zones Suffer High Rates of PTSD, Depression and Get Little Help
December 10, 2013
Private contractors who worked in Iraq, Afghanistan or other conflict environments over the past two years report suffering from post-traumatic stress disorder and depression more often than military personnel who served in recent conflicts, according to a new RAND Corporation study.
Researchers found that among the contractors studied, 25 percent met criteria for PTSD, 18 percent screened positive for depression and half reported alcohol misuse. Despite their troubles, relatively few get help either before or after deployment.
“Given the extensive use of contractors in conflict areas in recent years, these findings highlight a significant but often overlooked group of people struggling with the after-effects of working in a war zone,” said Molly Dunigan, co-author of the study and a political scientist with RAND, a nonprofit research organization.
The results are from an anonymous online survey of 660 people who had deployed on contract to a theater of conflict at least once between early 2011 and early 2013. The study attracted participants through several methods, including contacting individual companies and trade associations and posting links to the survey on websites and blogs. It is the first survey to examine a broad range of deployed contractors, not just those who provide security services.

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Medical: Security Issues–A Top Five, By Angela Benedict

The other day Angela wrote me to ask about some of the issues that contractors are having to deal with in the war and at home. Stuff that get’s us into trouble on the job or with our personal lives. It’s a good list, and a good start. I am sure there are other issues we could talk about and hopefully this will get the mental juices flowing out there. A big thanks to Angela for putting this together.

I also forgot to give her one more area that really messes with guys, and that is the money issue. Sometimes people get into contracting against their wishes, all because they are desperate. You have scenarios where guys are extremely burned out on anything to do with the war or the military, but they have a family they need to feed and jobs are scarce at home.  So they begrudgingly get into contracting, and introduce this bitterness to the work place. They might not have any respect at all for contracting and the very basic guard duty jobs they are doing, and this attitude gets them in trouble with their co-workers and management.

The other reason why I like posting this stuff is that this gives those out there that are suffering, more tools and ideas on how to cope. Angela is the only one out there that has reached out to this community with a helping hand, and I think she is an awesome person for doing so. As a result, I send folks her way all the time.

I also get the hard emails now and then, and all I can do is listen and try to channel them to persons and places that can help. I definitely do not want to see another Danny Fitzsimons scenario where a contractor is suffering and yet they keep going after jobs to stay employed. But these are the guys that are walking time bombs in the contractor workplace. We need to find these contractors and help them before they hurt themselves or others.

Which by the way, and I mentioned this to Angela, I do not know what the suicide statistics are for contractors. I imagine there have been quite a few suicides, just because many contractors already come from a past filled with trauma–either as a cop or veteran of a war. But there are no studies at all about this area of contracting. If I were to speculate, the rates of suicide would be similar to that of the military or police. But this is just speculation….

I am also interested in all and anything that will help to create mental resiliency for war zone work. Because we all deal with some kind of personal demon or issue which can have an impact on our work, health, or relationships, and it is important to create a personal battle plan on how to work through those issues. You need to be constantly learning about yourself and continuously improving upon what makes you strong and resilient mentally. The pay off is the ability to work in this industry for the long term and still maintain a life at home.  The other pay off is that your mental state will not interfere with your job, and your decision making process will be enhanced and focused on winning the fight. -Matt

Security Issues – A Top Five.
By Angela Benedict
August 30, 2011
Five of the most debilitating issues in security disciplines are; addictions, relationships, PTSD, physical pain and suicide. Addictions are tied to relationship problems.  Alcohol and women get many personnel into serious, life-altering trouble.  Alcohol is especially problematic as it has such an engrained historical place and therefore acceptance within military settings.  It is a cultural norm.  The devastating effects of its status are seen as unfortunate, but not serious enough to curtail the place it holds in the culture.  If this happened, the positive ripple effect would be immense.

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Medical: The Skin Gun

This is a cool invention. For the military or this industry, burns can come from all sorts of sources during a war. So stuff like this is awesome. Check it out. -Matt

 

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Medical: True Bionics, And Getting Back Into The Fight

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Job Tips: How To Get Into Security Contracting Without A Military Or Police Background

I wanted to do a post about this subject because of all of the emails I have been getting lately. In the past, I have hinted at this kind of stuff before, but I think now it deserves it’s own post.  The top question I get is ‘how do you become a security contractor without any military or police background?’. My top reply is for individuals to join the military or police, and get that background–with an emphasis on the combat arms and duty in the war.  That by far is the best route to go, and you will come up against the least amount of friction in this industry as you pursue your career in security contracting.

With that said, there is a way to become a gun carrying security contractor without that four year degree in the combat arms.  The loophole I am talking about is to become a paramedic. In my career, I have personally met three security contractors without any military or police background, that got their job as a gun carrying contractor because of their medical qualifications.  From PSD work to disaster response to site security work–these non-military/police contractors worked those gigs as gun carrying medical guys. Although not purely shooters, they are armed non-the-less, with an emphasis on their medical qualifications. That is what they were hired for, and they are right along side the guys who were contracted as shooters–much like how a combat medic is used in a military unit.

All three medical contractors I had met, were armed by their company so that they could defend self and/or client.  Out of the three I had met, two of them had invested in security/weapons training to supplement their medical certifications so they could be less of a liability in the field.  Most of them had to go through the same overseas type deployment spin up course, or similar company vetting to ensure they could operate well with whatever team they were assigned to. But to put it bluntly, paramedics/nurses/doctors are all highly valuable assets to companies, and companies will bend over backwards to get these guys out there on contract, and especially when medical assets are required for a specific contract. A company must look beyond a lack of military or police background with a job seeker to fulfill a contract requirement, just because there isn’t enough qualified medical folks out there willing to do this kind of work.

Which is the one caveat that I tell folks when they pursue this loophole of contracting.  I suggest to folks to not only get their paramedic certification, but to also invest in excellent security/weapons training that will at least introduce to them the basics of how to operate out there.  I really emphasize the weapons schools because most of the companies will have their medical contractors do a shooting test with the weapon they will be issued in the field as a requirement of the contract. At the least, a contractor should be proficient with a pistol and rifle, and any investment in weapons training will pay off in the long run when you pass that shooting test and get that six figure job overseas.

To take this a step further.  If by chance you are able to sign on to the WPS program, you will have to shoot and qualify with some of the belt fed weapons that this program uses. I have even heard of medical officers being used in training to teach the usage of weapons like the AK 47 or PKM on the TWISS program.  The point here is that once you get involved as a security/medical contractor, you should expect to be around weapons and know how to use them if you want to be useful and a  non-liability to the team. So get some good reputable weapons training, and learn the fundamentals. I suggest CSAT as a an excellent starting point if you are looking for ideas.

Of course you must also maintain your fitness level because companies will require a PT test as per the contract. Keep up to date mentally by following the latest news in this industry through the forums and blogs. You must also ensure your background checks clean for any kind of clearance issues, because in this war, the US government is using the ‘security clearance’ as a means of vetting. So keep your finances in check, keep your nose clean and do not lie on your SF 86 form.

The most important thing though is to maintain your paramedic certification and stay up to date on all the medical protocols. If you are a former 18 Delta or military medic, I still suggest getting the paramedic certification because it will help you to bridge your military experience to the civilian world.

I would even suggest some exposure to military themed medicine (TCCC) for those without a military/police background, through some of the private schools that offer such things. Deployment Medicine International is one such company that I can recommend, and with a search, you can find others.  Also, you can learn more about training by talking with other medical contractors via the forums.  That is what’s called networking and getting ‘locked on’, which will help you big time in your security contracting career.

Now I am sure there are other ways of becoming a security contractor besides the medical route, and hopefully some folks will put their ideas down in the comments section.  But personally, the medical angle is probably one of the best ways that I have seen to accomplish this task. It is also one of those certifications that will be quite useful when you are done doing the overseas contracting game and are wanting to settle back home.  You could spend all that money you earned on going to Nursing school or similar, and advance your career in the medical world.  The experience you gained as a medical professional in the war zones will also be highly respected back home in the hospitals and ambulances.

The other thing that I wanted to touch upon is that if you are a security contractor with a military or police background, and are wanting to increase your marketability in this industry, then getting a paramedic or EMT certification would be an outstanding move.  Even with executive protection gigs, out of two guys with equal shooter backgrounds applying for the same job, the guy that can save the client medically will be of higher value than the guy that does not have any medical experience or certifications. If you want an edge in this highly competitive world of security contracting overseas or at home, get that paramedic certification.  To me this is all about being the ‘Useful Contractor‘ and diversifying your capabilities.(Miyamoto Musashi would approve) This one investment could save your buddy or client’s life, it could get you that high dollar contract you have been dreaming about, and it could keep you marketable in a highly competitive industry both CONUS or OCONUS for years to come. Something to think about if you are coming up against a wall in your career path, or wanting to get a foot into the door of this highly competitive industry. -Matt

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Medical: ‘Experts’…. Look At Civilians Hurt Supporting War

     The most prevalent diagnoses for civilians were musculoskeletal/spine injuries (19 percent), combat-related injuries (14 percent) and circulatory disorders (13 percent). Among members of the military, the most common diagnoses were musculoskeletal (31 percent, 6.4 percent of them considered war-related), combat (14 percent) and psychiatric (9 percent).

     Cohen noted that civilians with psychiatric diagnoses were significantly more likely to return to duty (16 percent, versus 9 percent for soldiers). “Despite the military’s emphasis on screening and early treatment for psychiatric disorders, they still take a much greater toll on military personnel than nonmilitary personnel,” said Cohen, who is also director of Chronic Pain Research at Walter Reed Army Medical Center.

 

    After looking through this, I had some objections with the study. It is lumping in civil servants or federal employees with non-federal employees or civilian contractors.  The reason why I disagree with this combination is that federal employees would have different motivations and different compensations than civilian contractors. It would have been better to completely separate the two.

    Dr. Cohen said this as well–’Civilians, who often work in security and transportation jobs, are less likely to be in the line of fire and don’t expect to be injured in combat‘. I absolutely disagree with this statement and I am not sure how he came to this conclusion?  Even the KBR truck drivers that were hired to work in Iraq at this specific time line of the study (2004 to 2007) would have had to have known through the news and through word of mouth, that they were signing up for a very dangerous contract in an active war zone.

    The security contractors that worked at that time, and especially in Iraq, all considered the idea of being ‘injured’ or killed in combat every day they worked there.  How could a person in this position not consider this?

    This study also highlights some strengths and weaknesses of the contracting model in war zones, as it pertains to the medical side of things.  It shows how contractors view their job as a profession that will help to feed their family and pay the bills. The study makes no mention of that contractor’s patriotism or their desire to be with the team. The various motivations for them to continue going back to that war zone is varied, and this study does not differentiate. This study also represents a very dangerous time period to be a contractor, and a key time period of the development of the industry.

    On the other hand, the study pointed out that after civilians were wounded from ‘combat related’ injuries, they were more likely not to return.  Is that because they lost heart for the work or is that because the injury was debilitating enough to where they could not go back? Does the study make any mention of how many incidents that an individual had been through, both in their military history and contractor history?  Or how many of these folks have returned back to work after such incidents, but years later. This is happening in this industry, and the contracting model allows individuals to do this, dependent upon their resume and vetting.

    The other interesting statistic was this one. ‘Cohen noted that civilians with psychiatric diagnoses were significantly more likely to return to duty (16 percent, versus 9 percent for soldiers).’  This statistic needs to be clarified. How many of these folks that were questioned, were military veterans or police veterans that had carried their mental issues with them into their contract? Or what kind of diagnosis is given for each individual questioned, and was it related to combat and the war, or were these psychiatric issues a carry over from something else going on in their lives?

    With that said, the drive for a contractor with mental problems to continue working to feed their family and pay the bills, might be stronger than seeking help and not working.  At this time period of the study, a secret clearance was not mandatory. But there was the infamous CRC that many contractors had to cycle through at that time, and the military was tasked with medically screening folks.  At the bases that conducted this screening, contractor’s medical backgrounds were reviewed.

    Even with these screening processes, contractors still slip through.  Danny Fitzsimons is just one case of a contractor with mental issues making it through the system. There is also the peer review or on the ground management of teams that helps to screen folks as well. If there is an individual that is mentally unstable, they will be identified and removed from contract due to their liability. Everyone has to be a little crazy to do this work, but no one wants to depend their survival on some dude that is mentally gone.

     The high musculoskeletal/spine injuries statistic is the one statistic that was intriguing to me.  With the use of body armor and how heavy it is, as well as the hours of standing around or driving around wearing it, this can have adverse effects on the body.  Even though the armor can save a life, it still can injury a person just because of it’s weight. This is a problem for the military, and for contractors, and back injuries and the pain medications required to deal with those injuries will become very common place as contractors and military continuously work in war zones and wear this stuff. Armor is a paradox of sorts, and not to mention it’s limitations on the mobility of a war fighter. It may save your life, but it will also allow enemy combatants to out run you and give them a chance to fight again.

     Now what would be an interesting study is to pick up where they left off and see how things look now(2007 to 2011)?  A lot has happened since then.  If the study was better targeted and consultants outside of the medical group were asked to help guide the process, then that would be a more thorough and respected study. People will support what they help to create…. -Matt

Experts look at civilians hurt supporting war

February 21, 2011By Stephanie DesmonAfter analyzing data on 2,155 private contractors, diplomats and other civilians supporting war efforts in Iraq and Afghanistan who were medically evacuated from combat zones, researchers have found that such civilians are more likely to be evacuated for noncombat-related injuries but more likely to return to work in-country after treatment for these conditions.

Still, the findings of the Johns Hopkins–led research team, published online in CMAJ, the journal of the Canadian Medical Association, note that 75 percent of the nonmilitary group medically evacuated from the war zones to Landstuhl Regional Medical Center in Germany between 2004 and 2007 did not return to the field.

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