Feral Jundi

     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.

“Everyone is understandably focused on the troops, but wars have fundamentally changed. Today, roughly half of those deployed in Iraq and two-thirds in Afghanistan are not members of the military,” said study leader Steven P. Cohen, an associate professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine and a colonel in the U.S. Army Reserves. “These individuals are increasingly an integral part of the mission but have been almost completely ignored in the medical literature. That needs to change so that we can develop better methods of injury and disease prevention.”

Cohen suggests that money may be one main reason that nonmilitary personnel return to work more often than those in the military. “Private contractors and other civilian workers tend to have significantly higher salaries than soldiers, and if they don’t return to work on the ground in Iraq or Afghanistan, they don’t get paid,” he said. Soldiers, by contrast, will still get paid even if they are sent back to the United States, losing only the small percentage of their pay that’s attributed to hazardous duty.

The study showed that combat injuries were not the leading cause of evacuation for either military personnel or civilians. Musculoskeletal injuries were the leading cause of medical evacuation in both groups, with a higher proportion of soldiers suffering those injuries than civilians. In modern warfare, the researchers note, injuries sustained in combat have never been the leading source of soldier attrition. Respiratory and infectious diseases were the main causes from World War I through the Korean War. By Vietnam, nonbattle injuries (e.g., back pain, fractures, overuse injuries) had become the leading source of loss of unit strength, and have remained so ever since.

Not surprisingly, military personnel were more likely to be evacuated for war-related injuries than civilians, Cohen and his colleagues found. The study considered combat, traumatic brain and some musculoskeletal/spine injuries, as well as psychiatric conditions, suffered during operational missions to be war-related. 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, Cohen said. When they are, they are less likely to return to a war zone, with many concluding that the job “isn’t exactly what they signed up for.”

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.

The longer that wars continue, he added, the worse this problem will be. “The more times a soldier is deployed, the more likely he is to experience a psychiatric problem,” he said. “Instead of becoming more resistant, soldiers become more vulnerable.”

According to the study, 16 percent of military personnel returned to duty compared to 22 percent of civilians after being evacuated for a routine musculoskeletal or spine injury. Soldiers’ jobs tend to be more physically taxing than civilian jobs, Cohen said, making it harder, perhaps, for them to return to duty after such injuries. Civilian workers were more likely to be evacuated because of circulatory and heart problems, Cohen said, probably owing to their average older age (44.4 years compared to soldiers’ 29.8 years) and accompanying age-related disorders.

The study was funded in part by the John P. Murtha Neuroscience and Pain Institute, the U.S. Army and the Army Regional Anesthesia & Pain Medicine Initiative.

Charlie Brown, of Johns Hopkins, and Scott Strassels, of the University of Texas, also contributed to this research.

Story here.