Gov't Struggles to Care for Wounded
By THE ASSOCIATED PRESS
Published: June 24, 2007
Filed at 2:29 a.m. ET
More than 800 of them have lost an arm, a leg,
fingers or toes. More than 100 are blind. Dozens
need tubes and machines to keep them alive. Hundreds
are disfigured by burns, and thousands have brain
injuries and mangled minds.
These are America's war wounded, a toll that has
received less attention than the 3,500 troops killed
in Iraq. Depending on how you count them, they
number between 35,000 and 53,000.
More of them are coming home, with injuries of a
scope and magnitude the government did not predict
and is now struggling to treat.
''If we left Iraq tomorrow, we would have the legacy
of all these people for many years to come,'' said
Dr. Jeffrey Drazen, editor-in-chief of the New
England Journal of Medicine and an adviser to the
U.S. Department of Veterans Affairs. ''The military
simply wasn't prepared for its own success'' at
keeping severely wounded soldiers alive, he said.
Survival rates today are even higher than the record
levels set early in the war, thanks to body armor
and better care. For every American soldier or
Marine killed in Iraq, 15 others have survived
illness or injury there.
Unlike previous wars, few of them have been shot.
The signature weapon of this war -- the improvised
explosive device, or IED -- has left a signature
wound: traumatic brain injury.
Soldiers hit in the head or knocked out by blasts --
''getting your bell rung'' is the military euphemism
-- sometimes have no visible wounds but a fog of war
in their minds. They can be addled, irritable,
depressed and unaware they are impaired.
Only an estimated 2,000 cases of brain injury have
been treated, but doctors think many less obvious
cases have gone undetected. One small study found
that more than half of one group of wounded troops
arriving at Walter Reed Army Medical Center had
brain injuries. Around the nation, a new effort is
under way to check every returning man and woman for
Some of those on active duty may have subtle brain
damage that was missed when they were treated for
more visible wounds. Half of those wounded in action
returned to duty within 72 hours -- before some
brain injuries may have been apparent. The military
just adopted new procedures to spot these cases,
Back home, concerns grow about care. The Walter Reed
hospital scandal and problems with some VA nursing
homes have led Republicans and Democrats to call for
better care for this new crop of veterans.
A lucky few get Cadillac care at one of the VA's
four polytrauma centers, where the most complex
wounds are treated with state-of-the-art techniques
and whiz-bang devices like ''power knee'' or ''smart
ankle'' prosthetics. Others battle bureaucracy to
see doctors or get basic benefits in less ideal
Mental health problems loom large. More than a third
of troops received psychological counseling shortly
after returning from Iraq, and a third of those were
diagnosed with a problem, a recent Pentagon study
found. The government plans to add 200 psychologists
and social workers to help treat post-traumatic
stress disorder and other issues.
No one knows what the ultimate cost will be. Harvard
University economist Linda Bilmes estimates the
lifetime health-care tab for these troops will be
$250 billion to $650 billion -- a wide range but a
huge sum no matter how you slice it.
Who are the wounded?
Lee Jones, 24, of Lumberton, N.C., was severely
burned on the face, hands, feet and legs when his
Humvee was hit with an IED two years ago. A partial
amputee with speech and other problems from a severe
brain injury, he now does work therapy delivering
mail at a VA hospital and tries to re-establish life
in a nearby apartment with a wife and baby daughter.
Marine Cpl. Joshua Pitcher, 22, from upstate New
York, is a Purple Heart recipient who returned to
Iraq after he was shot in 2005. Half of his skull
was removed to allow his brain to swell as he now
recovers from a brain injury and shrapnel wounds
from a grenade blast in February.
Maj. Thomas Deierlein, 39, is a New York City
marketing executive who served five years after
graduating from West Point. Twelve years later,
called up as a reservist, he nearly died of bullet
wounds that shattered his pelvis, leaving him with a
colostomy and learning to walk again.
Joseph ''Jay'' Briseno, 24, of Manassas Park, Va.,
was shot in the back of the neck by an Iraqi in the
early months of the war. One of the most severely
wounded, he is now a quadriplegic, on a breathing
machine, blind and unable to speak, but aware of
what has happened to him.
''The mistake in Vietnam was, we hid the injured
away from folks so they didn't get to tell their
stories. Now it's important that we let them tell
their stories to the public,'' said Dr. Steven
Scott, director of the Polytrauma Rehabilitation
Center at the Tampa VA Medical Center in Florida.
Counting the wounded can be contentious. Earlier
this year, the Department of Defense changed how it
tallies war-related injuries and illness, dropping
those not needing air transport to a military
hospital from the bottom-line total.
Bilmes, the economist, thinks this is disingenuous.
''An accident that happens while they're there is a
cost of war, particularly when you factor in the
length of deployment'' and injury-inducing
conditions like very hot weather, carrying heavy
packs, and more vehicle accidents because it is not
safe to walk anywhere, she said.
As of June 2, 25,830 troops had been wounded in
action. Of these, 7,675 needed airlifts to military
hospitals and the rest were treated and remained in
There were another 27,103 non-battle-related air
transports. Of those, 7,188 had injuries. Most
occurred from vehicle accidents, training or
work-related accidents. Ten percent were sports
injuries, said Dr. Michael Kilpatrick, who tracks
this information for the Defense Department.
Nearly 20,000 of these ''non-hostile'' airlifts were
for illnesses or medical issues: general symptoms
like fever or pain needing tests or evaluation; back
problems; psychological problems adjusting to being
in a war zone; ''affective psychoses'' (not able to
function or care for themselves); neuroses;
respiratory or chest symptoms; depression; head and
neck problems (including traumatic brain injury);
epilepsy; infections, and muscle pulls and strains.
''I don't want to try to say these are not
war-related. Being in the military is a very
physically demanding job,'' Kilpatrick said.
For stress-related problems, the military tries
''three hots and a cot'' -- warm meals and a chance
to sleep. Most of the time it works and troops
return to their unit, Kilpatrick said.
Of the troops air evacuated to the military hospital
in Landstuhl, Germany, 20 percent return to Iraq and
80 percent go back to the United States for more
care or disability discharge.
Of the half-million troops who have left active duty
and are eligible for VA health care, about one-third
have sought it. The most complicated cases end up at
one of the four polytrauma centers, in Tampa, Fla.;
Richmond, Va.; Palo Alto, Calif.; and Minneapolis.
These were formed after doctors realized they were
missing problems -- amputees who were confused and
unable to put on their prosthetics because of
undiagnosed brain injuries, and guys who could
remember their therapy dog's name but not their
doctor's, or who could carry on a conversation but
not recall what they had for breakfast.
Troops at these hospitals have an average of six
major impairments and 10 specialists treating them.
''The important thing to realize is you could have
all of them at once'' -- trouble speaking, seeing,
walking, hearing, etc., Scott said.
Most of these injuries are caused by IED blasts,
which send a pressurized air wave through delicate
tissues like the brain, sometimes send it smacking
against the inside of the skull and shearing fragile
nerve connections that control speech, vision,
reasoning, memory and other functions. Lungs,
eardrums, spinal cords -- virtually anything -- can
be damaged by the pressure wave. Injuries also come
from collapsing buildings, flying debris, heat,
burns or inhaled gases and vapors.
''Many of these you can't see on an X-ray,'' such as
glass shards that can cause internal bleeding, Scott
In prior wars, one of every five to seven troops
surviving a war-related wound had a traumatic brain
injury, the military estimates. It's much higher in
A pilot project at Walter Reed in 2003 to screen 155
patients returning from Iraq found that 62 percent
had a brain injury.
''This is a very rapidly evolving area as a
disease,'' with no screening test, agreed-upon set
of symptoms for diagnosis, or even a billing code,
said Kilpatrick, the military doctor.
Much needs to be learned about how to treat these
injuries, he said, but credited the military medical
staff for having the chance.
''It's just amazing to me every day when I look at
these numbers,'' he said. ''The good news is that
the majority of these people who become ill or
injured ... are going to survive and are going to be
able to return either to the military or to civilian
life and be productive.''