Conference Coverage


Military Wounded Return, Seeking Opportunities

Laureen Doloresco of the VA Hospital in Tampa sounded a warning to Rehabilitation Nurses attending an annual conference in Florida.

Military Wounded Require a New Approach to Rehabilitation and Community Rentry.

Soldiers are surviving explosions in war at a much higher rate than ever before. Compared to the Vietnam injured who did not arrive in a U.S. hospital for up to 45 days, the solider wounded in Iraq is home in four days, according to Laureen Doloresco, MN, Associate Chief, Nursing Service for Spinal Cord Rehabilitation at James A. Haley Veterans’ Hospital in Tampa.

As a result injured military require more attention and careful diagnosis to their post-trauma care. “We have a new screening process in place to diagnose traumatic brain injury and post traumatic stress syndrome,” Doloresco told rehab nurses at their Florida State Conference held in Orlando. “The sheer force of roadside bombs can affect multiple areas of the body,” she noted.

The home made bombs often contain sharp objects designed to scatter as shrapnel. The blast itself often causes massive blunt trauma to the body. “Forty percent of the soldiers injured (in Iraq) suffer a crush injury,” Doloresco said. The result is that from one blast there are often multiple injuries, an average of four. “Traumatic brain injury is the signature injury with one fourth of the soldiers evacuated from the war zone sustaining TBI.”

In cases where the brain injury is not readily apparently, it often is not diagnosed until after the individual has returned home and family members notice a difference in personality.

From such cases, the Veterans’ Administration has developed a poly-trauma rehabilitation program designed to work with multiple injuries. There are four trauma centers in the United States; Tampa, FL, Minneapolis, MN, Palo Alto, CA and Richmond, VA.

Because of the national awareness and controversy over the war in Iraq, all of the Veterans Hospitals are working under a microscope from the media, politicians and the public. “And that is as it should be,” Doloresco said, although she admitted that it does a lot of stress and staff burnout.

The Veterans’ Administration has changed the way it operates to meet the needs of the “Millennium Generation” those in their early twenties. The VA has put in internet cafes, provides 24-7 visiting hours and, in Tampa, opened the Fisher House to provide a home away from home for military family members. There is also an assigned recovery coordinator for each patient.

Doloresco said that family members sit in on therapy sessions, provide input into care and learn how to perform procedures at home. “We are getting hyper-vigilance from the families,” she told the rehabilitation nurses.

The Veterans’ Administration has also taken on the role of providing the needed training an emotional support of the medical staff who work in the VA setting. “As rehabilitation nurses, we can expect to be providing care for these young men and women for many years to come. The greater lesson is that it is one way we can continue to honor our heroes,” Doloresco concluded.


Severely Injured Soldiers Will Require More Rehabilitation

 

Rehabilitation Nurses meeting in Orlando were educated on the rehabilitation needs of returning soldiers who have sustained limb loss. Shown are past presidents of FSARN.

Rehab Wars: Working with Returning Amputees

Kevin Carroll, is a prosthetist and researcher who has worked closely with returning injured soldiers from Iraq and Afghanistan. He is Vice President of Prosthetics for the Hanger Corporation and shared his knowledge and experience with attendees at the annual Florida State Association of Rehabilitation Nurses (FSARN) recently.

Carroll said that the war in Iraq is fought with roadside bombs that result in blasts that cause multiple amputations and brain injury. Returning soldiers with those types of injuries can require several years of rehabilitation to function well in society on prosthetic limbs.

“We have had soldiers who were blown up who spent two years in their power chair,” Carroll said, noting that often the high end and expensive prosthetic limbs remain in a closet, unused. “We asked them, are you willing to move away from the chair,” Carroll said.

If the person who has multiple amputations is willing, there is a commitment that has to be made that includes using low-tech, short legs to build up muscle strength, coordination and balance. “Then we start using longer prostheses and at the same time, we teach them how to fall, because they will,” Carroll noted.

He included video of some of his patients learning to walk up and down stairs, on grass, an escalator and on a hilly golf course. There are also lessons in how to fall and how to get up…. and how to get used to the stares when going out in public.

“The military wants to spend money to help the soldiers,” Carroll pointed out, but he added that a $120,000 limb doesn’t do any good if the individual is not taught how to use it correctly. When the individual does learn, the results can be amazing.

Rehabilitation nurses at the conference expressed awe at seeing young soldiers playing golf, driving manual shift sports cars and running races on their above-the-knee prostheses.

When asked what they could do, Carroll told the rehab nurses to let the insurance companies know the time and dedication it will take to rehabilitate individuals with multiple limb loss and medical complications from bomb blasts. “These young men and women just need to know there is someone in their corner,” he told the audience.

Ed. Note: Kevin Carroll, MS, CP, FAAOP is Vice President of Prosthetics at Hanger, an author and researcher. He is based in Oklahoma City, OK.


Florida Workers’ Comp Filings Moving Toward Electronic

Florida Chief Judge of Workers’ Compensaton Claims David Langham wants to hear from attorneys and adjusters.

Adjusters, Attorneys Advised

New Era Uses the
Best in Technology

A workers’ compensation blog where you can get the latest “open and honest” answers to your workers’ compensation question? A workers’ compensation judge “going live.” That is what is happening in the sometimes obscure world of workers’ compensation claims adjudication.

If you have any doubt just look up Chief Judge David Langham, Office of Judges of Workers’ Compensation Claims and he will tell you that it is a new era where speed and efficiency will go hand in hand with accuracy, equity and fairness.

Credit the new technology which allows for instant messaging, e-mail communications and electronic filing. According to a pamphlet put out by the Office of the Judges of Compensation Claims “Electronic Filing is Here” allowing attorneys to send any document directly to any OJCC District or Division over the internet.

Registered attorneys can file any document in any workers’ compensation case in which they have noted an appearance. Adjusters can also file electronically on cases in which they are involved.

Judge Langham not only support the technology, he is an advocate who recently talked with adjusters at the Workers’ Compensation Claims Professionals (WCCP) conference and encouraged them to communicate directly with him if they encounter issues in their regions.

“We are working to make the system accountable. There are 32 judges in Florida and we want you to let us know how we are doing,” Judge Langham said. He noted that while he cannot directly change the way a judge handles a given case, he can provide feedback to the judge. He encouraged adjusters to “empower themselves” to become involved in the process.

The E-Filing registration is free, saves time, paper, postage and delivery fees the state reports. Judge Langham encouraged adjusters and attorneys to offer their comments. Just visit the web site at www.fljcc.org and click on contact info and you are on your way to becoming part of the solution.

Ed. Note: Judge David Langham spoke at the WCCP conference in June and also spoke during a special breakout for attorneys at the Florida Workers’ Compensation Conference.


New Generation of Worker Offers Challenges

“Gen Y” Workers Often Seek Someone Else to Blame.

“It’s Not Fair”

Speaker Notes “Gen Y” Workers Often Seeking Someone Else to Blame

Bruce Wilkinson, CSP, believes he know why they call the latest generation the “Y Generation”, because when you tell them to do something, they ask “why?” Wilkinson brought his unique brand of humor and insight to an audience of professionals who work “to save people from themselves, in spite of themselves”, namely safety and health administrators.

The Georgia Safety, Health & Environmental Conference was held just outside of Atlanta, but it could have been anywhere in the U.S. because the issues and challenges are the same in today’s workplace.

“We live in a new society where people believe they can blame someone else when things go wrong,” Wilkinson told the audience. He said he knows of individuals who claimed they struck the car in front of them because the person in that car didn’t run a yellow traffic light. “It wasn’t their fault,” he said, drawing laughter from the audience.

“In the workplace 90% of accidents are human related,” Wilkinson said. “The number one cause of death of drivers of government vehicles is connected to drivers not using their seat belts,” he added. What does this mean for the current and future workplace? “Six million Generation Y individuals are entering the workforce each day,” Wilkinson pointed out.

They need education, the leadership expert admonished and it has to come from the employers and most specifically the front line supervisor with the full backing and support of the corporate leadership. Another phrased used by many of today’s young workers is “it’s not fair” when referring to discipline or work responsibilities. “Fair is not a characteristic of leadership. The world is not fair and the sooner young people understand that the better off they will be, he implied.

“Leaders have to choose to hold themselves accountable if employees are to believe them. They have to demand respect. Safety in the workplace has to be part of the value system of the company, not a priority,” Wilkinson pointed out. A priority is a matter of choice, he explained. Workplace safety is not an optional consideration. “We should be looking at many workplaces as places where there is ‘controlled danger’,” he emphasized.

The son of a Marine, Wilkinson grew up in a family where respect and discipline were routine but he admits that things are a bit different in today’s world. It isn’t a matter of simply saying something should be done because “I said so.” Except, perhaps, for the military, leaders have to learn and then teach. “This is a time for heros,” Wilkinson said.

As to why leaders lose respect, he cited three main causes: Not doing what you said you were going to do; no followup; no feedback. Bottom line, individuals don’t work for companies, they work for people they respect.”

Ed. Note: Bruce E. Wilkinson, is a Certified Speaking Professional (CSP), one of less than 500 worldwide to earn that designation. He is President and chief Leadership Officer of workplace Consultants, Inc., Wilkinson Seminars and Presentations.



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