Guide to Resources for Severely Wounded OIF/OEF Military Personnel
Military personnel in Iraq and Afghanistan are surviving wounds in numbers far greater than previous wars. Largely due to advances in body armor and combat medicine as well as the rapidity of evacuation, survivorship is close to ninety percent (Gawande 2004). However many wounded service members are surviving severe injuries which will require sophisticated, comprehensive, and often lifelong care. The purpose of this article is to identify helpful resources for healthcare professionals, veterans, and their families.
A shorter version of this article was originally published by Issues in Science and Technology Libraries, available at http://www.istl.org/07-fall/internet2.html
Introduction
Military personnel in Iraq and Afghanistan are surviving wounds in numbers far greater than previous wars. Largely due to advances in body armor, combat medicine, and the rapidity of evacuation, survivorship is close to ninety percent.1 However many wounded service members are surviving severe injuries which will require sophisticated, comprehensive, and often lifelong care. The purpose of this article is to provide an overview of the types of wounds being sustained and to identify helpful resources for healthcare professionals, veterans, and their families.
The United States military reports that 27, 506 service members have been wounded in action in Operation Iraqi Freedom (OIF) as of August 22, 2007 and that 1, 499 have been wounded in action while serving in Operation Enduring Freedom (OEF). Of this total, about half returned to duty in seventy-two hours.2
As previously mentioned, about 90% of OEF/OIF wounded service members are surviving, which is a rate that exceeds that of the Vietnam War (72%), World War II (62%), and the Civil War (44%).3 The major cause of injury is from blasts, especially from improvised explosive devices. According to the Defense Manpower Data Center4, explosive devices are responsible for 65% of casualties from the Global War on Terrorism (a term which denotes both the conflicts in Iraq and Afghanistan). Explosive devices produce characteristic injuries: traumatic brain injury (TBI), blindness, spinal cord injuries, burns, and damage to the limbs resulting in amputation.
Traumatic Brain Injury
Because of its prevalence, traumatic brain injury (TBI) has been called the "signature injury" of the wars in Iraq and Afghanistan. As of March 31, 2006, 1179 military personnel have suffered TBI's.5 Instances of TBI comprise 28% of medical evacuations.6
Most traumatic brain injuries sustained in OEF/OIF are caused by improvised explosive devices (IEDs) and other blasts (e.g. rocket propelled grenades or car bombs). The blasts create changes in air pressure that can damage the brain through concussion or contusion, as well as through the production of cerebral infarcts.7 Objects set in motion by the blast can penetrate the brain, causing secondary injuries. Tertiary injuries can result from being thrown during the blast, and other injuries such as burns and inhalation of toxic fumes can also result.8
TBI's that do not involve penetration of the skull are called closed traumatic brain injuries, and these are the more common types of TBI's being sustained by troops in Iraq and Afghanistan.6 Kevlar helmets do not protect against this type of injury.7 Those suffering from closed traumatic brain injuries may not exhibit any physical wounds, and if the case is mild, it may go unrecognized and untreated.9
Traumatic brain injury can cause attention, memory, and language problems as well as headaches, sleep disturbances, and personality changes. 7 Those with mild TBI usually recover within a year, but those with moderate and severe TBI may never recover fully. 7
The same traumatic incident may result in both TBI and post-traumatic stress disorder. Since these conditions have overlapping symptoms there is a possibility that one disorder may mask the other.6, 10
Post-Traumatic Stress Disorder
Post-traumatic stress disorder is a mental health disorder commonly experienced by war veterans, rape victims, and others who have endured traumatic events. It is characterized by hypervigilance, avoidance, numbing, and re-experiencing of the traumatic event.11 The unique nature of the current conflicts, which include multiple and lengthy deployments, urban warfare, terrorist attacks, and the ever present threat from roadside bombs, places special burdens on military service members. Military personnel may not report PTSD symptoms due to a perceived or actual stigma associated with the disorder, or of concerns related to career advancement.11 Consequently PTSD may be underreported and may go untreated.
Of 103, 788 OEF/OIF veterans seen at VA facilities between 9/30/2001 and 9/30/2005, twenty five percent were diagnosed with mental health disorders.12 The most common diagnosis was PTSD (13%); however diagnoses of anxiety disorder, adjustment disorder, depression and substance abuse disorder were also made. A significant finding was that fifty-six percent of those diagnosed with mental health disorders received two or more distinct mental health diagnoses.
As previously mentioned, many military service members may experience both PTSD and traumatic brain injury simultaneously. This complicates proper diagnosis and recovery, since the disorders have overlapping symptoms, yet different treatments.
Amputations
Protective gear worn in OEF/OIF has prevented many fatal abdominal or chest wounds but has shifted the pattern of injury to limbs, which are largely unprotected.13, 14 As of July 2007, 911 amputations had been sustained during OEF and OIF15, a significant portion due to IEDs (42.1%)5. This is a rate 2.5% higher than in previous wars.14 Lower extremity limb loss is more common (72%) than upper extremity loss. In addition, 16% of amputees have lost multiple limbs.16
The U.S. Army has established an Amputee Patient Care Program based at Walter Reed Army Medical Center and Brooke Army Medical Center. This program includes a multi-disciplinary team of surgeons, physical therapists, psychiatrists, occupational therapists, and many others and is considered state of the art.16
Eye Injuries
Eye injuries have increased over time on the battlefield14, 17 owing mainly to weaponry which produces small fragments that can lodge in the eye. Increased survivability due to protective gear also probably plays a role; the body core is protected while often the face is not.17 Battle eye injuries accounted for 15.8% of all medical evacuations carried out from March 2003-December 2004 in Iraq and Afghanistan. Of these, 70% were caused by IEDs, rocket propelled grenades, or shrapnel. 17 According to the President's Commission on Care for America's Returning War Wounded, approximately 48 service members have been blinded during the wars in Iraq and Afghanistan.9
The Veterans Administration administers specialized inpatient and outpatient centers for blind veterans around the country which offer a range of rehabilitation programs.
Spinal cord injuries
In a war zone, there are many causes of spinal cord injuries, such as gunshot wounds, explosive devices, and vehicle accidents. According to the President's Commission on Care for America's Returning Wounded Warriors (PCCWW), 94 service members have sustained spinal cord injuries in OEF/OIF.9 Spinal cord injuries are classified as either complete or incomplete. Complete spinal cord injuries usually result in the loss of function below the point of injury, leading to paralysis and loss of sensation. Incomplete spinal cord injuries may result in some but not all loss of function.18
Burns
As in previous wars, burns continue to be a source of injury for military personnel. The PCCWW reports that 598 service members have sustained serious burns in OEF/OIF9. Five percent of evacuations from OEF/OIF are due to burns as the primary source of injury.19 Of these roughly half are due to explosive devices, mostly either IED's or car bombs. The hands and head, often unprotected areas, are the most common burn sites. Although burns to these areas are often small in size, they are difficult to treat and can lead to functional impairment.19
Polytrauma
Although each of these wounds, amputations, TBI's, and eye injuries, have been discussed separately, the reality is that many service members are sustaining more than one of them. Explosions and blasts, the most common source of injuries in OIF and OEF, often cause injuries to more than one body system.
Recognizing the existence of polytrauma and the lack of comprehensive treatment and rehabilitation programs and protocols for it, the Thayer School of Engineering at Dartmouth hosted a Polytrauma Conference in December 2006.20
The Veterans Administration has established special Polytrauma Rehabilitation Centers (PRC's) to treat and rehabilitate military service members and veterans suffering from serious injuries to more than one body system. Well over 200 military service members have been seen by the PRC's since they opened.21
The severity, complexity, and multi-site nature of the wounds being sustained by troops in OEF/OIF makes it imperative that healthcare professionals, wounded military personnel, veterans, and their families know where to go to find reliable, trustworthy information.
SELECTION OF SITES
Three primary selection criteria were used to identify sites for inclusion: credibility, quantity of information, and accessibility. Credible information was defined to be that which was produced by a professional association, non-profit organization, educational institution, or government body. Commercial sites were not included unless they happened to host blogs, support groups or the like. Judging whether a site contained a substantial amount of information is a subjective measure, but doing so was necessary in order to exclude websites that consisted solely of contact information and a brief summary of the organization. In place of those types of websites, sites containing detailed information that would be useful to wounded veterans, their families, and healthcare providers were chosen for inclusion. Freely accessible sites (no charge and open to anyone) were preferred for inclusion; however several sites that require registration and/or contain members-only sections were included because of their relevance to wounded OEF/OIF military personnel and veterans.
Internet search engines and reputable sites such as the Veterans Administration and MedlinePlus were searched to identify websites for inclusion.
RESOURCES
General
Air Force Palace HART
http://www.af.mil/news/story.asp?id=123046952
The Palace HART program provides various services for wounded airmen. These services include assistance with remaining on active duty if possible as well as benefit and employment services. Palace HART does not have its own website but the link provided above is a news story that discusses some of the specifics of the program.
Army Behavioral Health
http://www.behavioralhealth.army.mil/
The Army Behavioral Health site is a large, comprehensive site from the U.S. Army Medical Department. The site includes many resources for soldiers and their families including fact sheets and forms related to all aspects of mental health. In particular there are many information resources about TBI and PTSD, preparing for deployment and readjusting post-deployment.
Disabled American Veterans
http://www.dav.org/
A major advocacy and service organization for disabled veterans, the DAV has many programs to assist OEF/OIF veterans. The DAV offers assistance with transition from service to civilian life by playing a consultant and representative role in the discharge, disability evaluation, and claims processes. The legislative action section of the website provides updates on current legislation related to disabled veterans and ways to take action.
Fisher House Foundation
http://www.fisherhouse.org/
The Fisher House Foundation builds houses on the grounds of major military and VA medical centers for family members to stay nearby while an injured or ill service member is being treated.
Homes for Our Troops
http://www.homesforourtroops.org
Homes for Our Troops is a service organization which raises funds and coordinates the building of homes or adapting of homes for severely wounded service members. Over 20 homes around the country have been built or adapted so far, with plans for many more.
Injured Soldiers Foundation
http://www.injuredsoldiers.org/
This foundation is a non-profit organization that sponsors various outdoor activities for wounded soldiers such as hunting and fishing trips.
Iraq and Afghanistan Veterans of America
http://www.iava.org/
IAVA is a membership organization comprised of veterans from OEF/OIF. Information can be found here on a variety of issues important to veterans, such as PTSD and traumatic brain injury. The Press Room section contains video clips from IAVA media appearances, press releases and newsletters. The website also hosts an online community, Troopnet, for OEF/OIF veterans to connect with each other.
Marine Parents
http://www.usmcparents.com/forum/default.asp?group=35
A support group for parents of Marines. The website has many discussion boards, including ones for PTSD, Wounded in Action, and post deployment concerns. Anyone can view postings, but to post one must first create an account (free). Many other resources are available on the site, including information about various service and assistance projects that the group sponsors.
Marine for Life
https://www.m4l.usmc.mil/
Marine for Life is a program of the US Marine Corps to help marines transition to civilian life. The Injured Support page provides resources for wounded marines and sailors including benefit information, disability calculators (for estimating benefits), downloadable forms, and information on specific injuries such as TBI, burns, and vision impairment. The main site, Marine for Life <http://www.m4l.usmc.mil/> contains other valuable resources, such as a job board and a mentoring network.
MedlinePlus-Veterans and Military Health
http://www.nlm.nih.gov/medlineplus/veteransandmilitaryhealth.html
MedlinePlus is a very large consumer health portal from the National Library of Medicine. The Veterans and Military Health section contains links to news items, treatment and rehabilitation information, directories, dictionaries, and many other resources. The Go Local link features resources available in a locality, such as healthcare providers, support groups, clinics, hospitals, and social services.
Military Severely Injured Support Page
http://www.militaryhomefront.dod.mil/portal/page/itc/MHF/MHF_HOME_1?section_id=20.40.500.393.0.0.0.0.0
This page is a section of the web portal MilitaryHOMEFRONT, created by the Department of Defense. It includes news articles about the severely injured, Our Hero Handbook: A Guide for Families of Wounded Service Members, and information about the Heroes to Hometowns program and Operation Warfighter program.
Navy Safe Harbor
http://www.npc.navy.mil/CommandSupport/SafeHarbor/
The Navy's Safe Harbor program provides services for severely injured sailors which include outreach, visitation, transition services, and aid with returning to active duty. Information is available on the site about specific injuries, workplace, education, job training, and counseling.
PDHealth.mil
http://www.pdhealth.mil/
A site created by the Deployment Health Clinical Center for clinicians treating service men and women after deployment. There are many resources on PTSD and TBI, as well as other subjects of interest to clinicians. Training videos, fact sheets, as well clinical guidelines and policies, are among the many resources available. A companion site for veterans can be found at <http://www.pdhealth.mil/veterans/default.asp>, and for families at <http://www.pdhealth.mil/family.asp>, and for the Reserve Component at <http://www.pdhealth.mil/reservist/default.asp>
Project Healing Waters Fly Fishing Inc.
http://www.projecthealingwaters.org/
This service organization which helps wounded veterans learn or relearn fly fishing and fly-tying. Clinics, classes, and outings are held all around the country. The site contains a calendar of events.
Seamless Transition
http://www.seamlesstransition.va.gov/
Seamless Transition is a VA website for returning OIF/OEF Active duty, Reserve and National Guard members. The site provides information about the medical, financial and other benefits offered to veterans and their dependents. It is also possible to apply for benefits online using the VONAPP (Veterans Online Application). VA facilities can be located using the "Find a Facility" dropdown menu.
Specially Adapted Housing Program
http://www.homeloans.va.gov/sah.htm
The Veterans Administration offers grants to veterans with service connected disabilities for the purposes of constructing an adapted dwelling or retrofitting an existing one. The site includes information about the grants, application forms, and pictures of specially adapted homes.
The Impact of War
http://www.npr.org/templates/topics/topic.php?topicId=1078
National Public Radio devoted a section of its website to news and features on all aspects of the conflicts in Iraq and Afghanistan. There is a great deal of coverage on wounded military personnel, as well as remembrances of fallen service members. The site features a combination of text and audio. An RSS feed is also available.
U.S. Army Wounded Warrior Program
http://aw2portal.com/
The U.S. Army Wounded Warrior Program is a Department of the Army advocacy program for wounded, ill and injured soldiers. The site contains many resources, some of which are only available to members. These include a job board, discussion forms, blogs, podcasts, and other resources. Only soldiers who have suffered severe injuries, as defined by the program, may join as well as their family members and care providers. Anyone may browse the news features and a large collection of links.
VA Polytrauma System of Care
http://www.polytrauma.va.gov/
The VA has setup a network of rehabilitation centers to assist veterans suffering from injuries to more than one organ system. These centers provide acute and post-acute care and rehabilitation using multidisciplinary health care teams. The site includes information about the network, and a facility finder.
Veterans Administration Vocational Rehabilitation and Employment Program
http://www.vba.va.gov/bln/vre/index.htm
The VA's vocational rehabilitation and employment program is for veterans with service connected disabilities. The site provides information on services, such as the independent living program, vocational and educational counseling, and the vetsuccess.gov employment resource center.
Wounded Warrior Project
http://www.woundedwarriorproject.org/
The Wounded Warrior Project sponsors a variety of programs including the distribution of backpacks filled with personal care and comfort items sent to severely wounded service members as they arrive to trauma centers; benefits, counseling, financial assistance and other services. The Wounded Warrior Project also offers sports and outdoors programs in collaboration with Disabled Sports USA <http://www.dsusa.org>. The site contains an online store, advocacy information, news articles, videos, press releases, position papers, biographical sketches of wounded warriors, and upcoming events calendar.
Resources for Traumatic Brain Injury
Brain Injury Association of America
http://www.biausa.org/
BIAUSA is a national organization serving people with TBI. The website contains information on TBI, a bookstore, state contacts, information on clinical trials, creative writing from survivors of brain injury (Survivor's Voice), position statements, and media resources.
Center for Outcome Measurement in Brain Injury (COMBI)
http://www.tbims.org/combi/
For researchers and clinicians, the COMBI is a resource of outcomes measures for TBI. For each measure there is background information, rating forms, and references. There is also online newsletter and discussion forums.
Defense and Veterans Brain Injury Center
http://www.dvbic.org/
A collaboration between the VA, Department of Defense, and NeuroCare, Inc, the Defense and Veterans Brain Injury Center is a clinical care and research organization for traumatic brain injury. Helpful resources include a documentary that can be viewed online, a TBI screening tool, and a variety of FAQs, fact sheets, and links.
MedlinePlus-Head and Brain Injuries
http://www.nlm.nih.gov/medlineplus/headandbraininjuries.html
MedlinePlus is a very large consumer health portal from the National Library of Medicine. The Head and Brain Injury section contains links to news items, treatment and rehabilitation information, directories, dictionaries, and many other resources. The Go Local link features resources available in a locality, such as healthcare providers, support groups, clinics, hospitals, and social services.
National Resource Center for Traumatic Brain Injury
http://www.neuro.pmr.vcu.edu/
The National Resource Center's site has some fact sheets and other information about TBI that is available free of charge (follow the links "FAQs" or "Article Reprints). They also sell books, DVDs, assessment tools, and kits for support group leaders in their online store.
Federal TBI Program
http://www.mchb.hrsa.gov/programs/tbi.htm
The U.S. Department of Health and Human Services offers TBI grants to state agencies. The site describes the grant programs available, along with some background information on TBI and the TBI Act of 1996. Grantees may participate in the TBI Collaboration space <http://tbitac.nashia.org/tbics/> an online space for collaboration which features a repository of contact information, ideas and best practices, and reports.
PTSD Resources
Aftermath of War Coping with PTSD
http://groups.msn.com/AftermathofwarcopingwithPTSDtoo
This online support group for PTSD contains dozens of message boards related to different aspects of PTSD, such as triggers, claims help, medications, and poetry corner. Anyone can view posts, but to make a post it is necessary to register first (free).
Combat Stress Reactions: Normal responses to abnormal conditions
http://www.lifelines.navy.mil/dav/lsnmedia/LSN/CombatStress/
This set of video presentations about combat stress and PTSD is presented by the Naval Personnel Development Command. Presentations are available in Windows Media and RealMedia formats.
Iraq War Veterans PTSD page
http://www.iraqwarveterans.org/ptsd.htm
This page serves as a portal to support groups (many of which are online), information and news resources on PTSD.
Military Veterans PTSD Manual
http://www.ptsdmanual.com/
The manual is a book published by a disabled Vietnam veteran. Parts of the book are available freely online and the entirety of the book can be purchased in print or in electronic form. The book contains a lot of practical information about how to work with the VA to obtain assistance, including the types of forms and documentation that will be required and how to navigate the system.
National Center for Post Traumatic Stress Disorder (NCPTSD)
http://www.ncptsd.va.gov
This site, from the Veterans Administration, is a major clearinghouse for information on PTSD. One subsection of the site is the PTSD Information Center which contains resources for healthcare professionals, mental healthcare providers, veterans, their families, and researchers. PTSD 101, an online curriculum for mental healthcare providers is available free of charge. The course is divided up into several modules, and the CE credit is available. Each module contains a
PowerPoint presentation with audio. A press room with fact sheets and information for the media is available. PILOTS is a freely accessibly electronic database to literature on PTSD and can be searched from the site.
One Freedom Inc.
http://www.onefreedom.org/
One Freedom is a non-profit organization in Colorado which offers free workshops and retreats for OIF/OEF veterans and their families in order to cope with combat stress and trauma.
Post-Traumatic Stress Disorder-MedlinePlus
http://www.nlm.nih.gov/medlineplus/posttraumaticstressdisorder.html
MedlinePlus is a large portal of reliable health information written for the layperson. The PTSD site contains links to information on a variety of aspects of PTSD, such as treatment and diagnosis, in both English and Spanish. Links to local health providers and services for PTSD can be found by following the Go Local link on the page.
Post-traumatic stress disorder-National Institute of Mental Health
http://www.nimh.nih.gov/healthinformation/ptsdmenu.cfm
A set of resources on PTSD written for the layperson.
PTSD Combat: Winning the War Within
http://ptsdcombat.blogspot.com/
The blog written by Ilona Meagher, author of "Moving a Nation to Care: Post-Traumatic Stress Disorder and America's Returning Troops" contains news items, podcasts, and vodcasts related to PTSD, as well as an event/action calendar and links to other PTSD resources.
PTSD Message Board on Iraq War Veterans Forum
http://groups.msn.com/IraqWarVeterans/ptsdiraq.msnw
The forum is a quite active message board for veterans, family, and friends affected by PTSD. Anyone can read postings, but to post it is necessary to join the group (free).
Vet Centers
http://www.va.gov/rcs/
The VA has established 207 community-based Vet Centers which provide free counseling services to veterans who served in a combat zone and received a military campaign ribbon as well as to their families. The website describes the services offered and provides a facility locator and contact information.
Vietnam Veterans of America Guide on PTSD
http://www.vva.org/benefits/ptsd.htm
This site provides a very practical guide on how to present a claim to the VA for PTSD.
Amputee Resources
Amputee Coalition of America
http://www.amputee-coalition.org/
The coalition is a non profit organization founded for the purposes of education and advocacy. The "Advocacy Action Center" section of the website is very comprehensive, with information on how to get involved in various advocacy efforts, updates on state and federal legislative efforts, and organizing and advocacy training events. The Information Center section of the website contains links to the National Limb Loss Information Center library catalog, the full text of articles (including Easy to Read articles), and a newsletter. Information specialists at the Center will answer questions by online form, fax, phone, or mail. Other resources available on the ACA website include online support groups, a store, and program and event information. A fair amount of the site's content is available in Spanish.
Clinical trials.gov-Amputation
http://clinicaltrials.gov/search/condition=amputation&recruiting=true
This directory of clinical trials related to amputees and amputation is from the National Institutes of Health. It provides information about upcoming, currently recruiting, and completed trials. Purpose of the trial, enrollment eligibility, and contact information for each trial are included.
Medlineplus: Amputees
http://www.nlm.nih.gov/medlineplus/amputees.html
This section of Medlineplus, a very large consumer health portal, is devoted to the topic of amputation. It contains links to a variety of information sources of interest to amputees in both English and Spanish. The Go Local link features resources available in a locality, such as healthcare providers, support groups, clinics, hospitals, and social services.
National Amputation Foundation
http://www.nationalamputation.org/
Originally founded to serve veterans, the NAF now also serves civilian amputees. The Foundation's AMP to AMP program is a peer counseling program available for new amputees.
UpperEx.com
http://www.upperex.com/
This site for upper extremity amputees includes a free bi-monthly magazine, peer support program, links to support groups around the world, daily living tips and tricks, and an events calendar.
The Open Prosthetics Project
http://openprosthetics.org/
The Open Prosthetics Project is a collaborative effort amongst prosthetics designers, engineers, and prosthetics users in which designs for new prosthetics are made freely available with no restrictions on their use (public domain designs).
War Amputees-Iraq and Afghanistan
http://iamputees.blogspot.com/
This blog contains compiled information and news about and for amputees from the OEF and OIF.
Resources for Spinal Cord Injuries
National Spinal Cord Injury Association
http://www.spinalcord.org/
The NSCIA is a non-profit organization involved in education and advocacy related to spinal cord injuries and diseases (SCI/D). There is a lot of information written at a consumer/layperson level about SCI/D in the "New Injury" section and in A-Z Resources. There is also a state directory of resources, legal information, and a forum.
MedlinePlus-Spinal Cord Injuries
http://www.nlm.nih.gov/medlineplus/spinalcordinjuries.html
This section of Medlineplus, a very large consumer health portal from the National Library of Medicine, is devoted to spinal cord injuries. It contains links to a variety of information sources such as tutorials, fact sheets, statistics, and directories in both English and Spanish. The Go Local link features resources available in a locality, such as healthcare providers, support groups, clinics, hospitals, and social services.
Paralyzed Veterans of America (PVA)
http://www.pva.org/
PVA is a non-profit organization of veterans with spinal cord injuries and diseases (SCI/D). The site contains overview information on SCI/D, information on disability rights, accessibility design, and other topics. The bookstore contains a variety of freely available print and online publications as well as publications for sale. The PVA sponsors the National Veterans Wheelchair games each year.
United Spinal Association
http://www.unitedspinal.org/
The United Spinal Association is a non-profit membership organization by and for those with spinal cord injuries and diseases and offers consultations to members in a range of areas including legal assistance, adaptive technology, and locating providers. VetsFirst is a national program that offers VA benefit and claim processing assistance. Using the advocacy section a user can create a customizable email message to lawmakers related to current issues and legislation affecting those with SCI/D. The Publication and Resources section contains more than 1000 informative articles (some of which are also available in Spanish), online magazines, wheelchair and assistive technology reviews, and other resources.
Resources for Burns
American Burn Association
http://www.ameriburn.org/
The ABA is a membership organization of healthcare providers supporting research, education, patient care, and advocacy for burn injury. The site contains advocacy resources, burn prevention information, and professional development opportunities for healthcare professionals such as annual meetings and symposia. In conjunction with the American College of Surgeons, the ABA administers the Burn Center Verification Program, for which burn centers can qualify if they meet strict standards.
Medlineplus-Burns
http://www.nlm.nih.gov/medlineplus/burns.html
This section of Medlineplus, a very large consumer health portal from the National Library of Medicine, is devoted to burns. It contains links to a variety of information sources such as tutorials, fact sheets, statistics, and directories in both English and Spanish. The Go Local link features resources available in a locality, such as healthcare providers, support groups, clinics, hospitals, and social services.
The Phoenix Society for Burn Survivors
http://www.phoenix-society.org/
This society is a national advocacy and education group for those with burn injuries. The site contains information about the Society's programs, chatrooms, a directory of local resources, and articles for survivors, family, and caregivers.
Burn Survivors Online
http://www.burnsurvivorsonline.com/
Burn Survivors Online is an information and support group for burn survivors. There are chat rooms, discussion forums, and articles.
Resources for blindness and eye injuries
American Foundation for the Blind (AFB)
http://www.afb.org/
The AFB offers information on blindness and low vision, message boards, online books for purchase, an annual conference for families of children with vision impairments, online professional development courses, statistics, and a directory of services.
Blinded Veterans Association (BVA)
http://www.bva.org/
The BVA is an organization of and for blinded veterans. Each year the organization holds a National Convention, which includes educational and informational events, as well as a venue for recently blinded veterans to meet and gain strength from blinded veterans from earlier conflicts. Several services are offered by BVA including scholarship and field representatives who travel to recently blinded veterans to provide support services
National Federation for the Blind
http://www.nfb.org
The National Federation for the Blind is a membership organization for the vision impaired.
The site is rich, with programmatic information, resources for living, working, learning and recreation, an online store of devices, books, and other items to increase independence, and a free online newsletter Future Reflections.
Veterans Administration Blind Rehabilitation Service
http://www1.va.gov/blindrehab/
The VA's Blind Rehabilitation Service website provides information about services offered, which include mobility and living skills on an inpatient basis at Blind Rehabilitation Centers (about a dozen of them around the country). There are also several outpatient programs, known as VICTORS and VISOR as well as Blind Rehabilitation Outpatient Specialists available in about two dozen cities.
References
1. Gawande, A. "Casualties of war--military care for the wounded from Iraq and Afghanistan." New England Journal of Medicine 351, no.24 (2004):2471-2475.
2. U.S. Department of Defense. OIF/OEF Casualty Statistics http://www.defenselink.mil/news/casualty.pdf (accessed 22 August 2007).
3. U.S. Department of Veterans Affairs (2006) American's Wars. http://www1.va.gov/opa/fact/amwars.asp on 16 July 2007. (accessed on 16 July 2007)
4. Defense Manpower Data Center (2007). Global War on Terrorism Casualty Statistics by Reason http://siadapp.dmdc.osd.mil/personnel/CASUALTY/gwot_reason.pdf (accessed 26 August 2007)
5. Fischer, H. (2006) United States Military Casualty Statistics: Operation Iraqi Freedom and Operation Enduring Freedom. Congressional Research Service Report #RS22452. http://www.fas.org/sgp/crs/natsec/RS22452.pdf (accessed 15 August 2007)
6. Warden, D. "Military TBI during the Iraq and Afghanistan Wars." Journal of Head Trauma Rehabilitation 21, no.5 (2006):398-402.
7. Okie, S. "Traumatic brain injury in the war zone." New England Journal of Medicine 352, no.20 (2005): 2043-2047.
8. Scott, S.G., Belanger, H.G., Vanderpoeg, R.D., Massengale, J., Scholter, J. "Mechanism of injury approach to evaluating patients with blast related polytrauma." Journal of the American Osteopathic Association 106 (2006): 265-270.
9. President's Commission on Care for America's Returning Wounded Warriors (2007). Serve, support, simplify: report of the President's Commission on Care for American's Returning Wounded Warriors http:///www.pccww.gov (accessed 17 August 2007).
10. Colarusso, L.M. "Concerns grow about war veterans' misdiagnoses: brain injuries can defy easy detection." Boston Globe June 10, 2007 http://www.boston.com/news/nation/articles/2007/06/10/concerns_grow_about_war_veterans_misdiagnoses/ (accessed 15 August 2007).
11. Friedman, M.J. "Posttraumatic stress disorder among military returnees from Afghanistan and Iraq." American Journal of Psychiatry 163, no. 4 (2006):586-593.
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