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.