By Staff Sgt. Don Branum 332nd Air Expeditionary Wing Public AffairsNovember 7, 2008
JOINT BASE BALAD, Iraq -- Air Force and Army medics here work as an integrated team to treat post-traumatic stress disorder and traumatic brain injuries, two of the most common injuries to affect wounded warriors.
The cooperation between services does more than contribute to the Air Force Theater Hospital's 98-percent survival rate -- it reduces the number of servicemembers who must be aeromedically evacuated from the theater, said Col. (Dr.) Mark Mavity, 332nd Expeditionary Medical Group commander.
The Army provides neurosurgical capability through the 207th Medical Detachment head and neck team and acute stress care through the 56th Multifunctional Medical Brigade.
"We have the only neurosurgical capability in Iraq," said Mavity, who has previously served as chief of operational medicine for the Office of the Surgeon General at Bolling Air Force Base, D.C.
Time is precious when someone suffers a head injury, said Army Maj. (Dr.) Shaden Marzouk, a neurosurgeon with the 207th MD. Injuries to the brain or skull can cause fluid to build up inside a patient's skull, creating pressure on the brain. If the pressure becomes too great, the top part of the brain, or cerebrum, pushes into the medulla -- the portion of the brain that controls the heart, lungs and other involuntary organ systems.
"Patients with traumatic brain injuries need immediate care to preclude that injury from becoming fatal," Mavity said.
Neurosurgeons can treat the pressure buildup through a surgical procedure called decompressive craniectomy, which involves removing a small part of the skull. Until recently, however, patients had to be flown to Joint Base Balad in order to receive the treatment.
"There's not always enough time to get the patient here in time to do that, so we've had the neurosurgeons fly out and teach some basic life-saving procedures to medics at other combat area support hospitals throughout Iraq," Mavity said. "That way, patients will survive long enough to get to Balad."
The Air Force Clinic here provides non-emergency medical services to Airmen and Soldiers. Here, the Army works with the Air Force to provide for patients' mental health needs, said Lt. Col. (Dr.) Jim Whitworth, officer in charge of the mental health clinic.
The mental health clinic helps patients deal with traumatic brain injury cases, most of which are mild concussions, said Maj. (Dr.) Rich Barker, a psychologist with the Air Force Mental Health Clinic here. The clinic focuses on detecting and treating acute stress, which can be attributed to either post-traumatic stress disorder or mild traumatic brain injury.
"Two years ago, when people got involved with falls or (improvised explosive device) blasts, they'd either press on without seeing a doctor, or they'd see a doctor and get sent back to a military treatment facility in Germany or the United States," said Barker, a Phoenix native who is deployed from Elmendorf Air Force Base, Alaska.
Thanks to education efforts, however, the number of people seeking treatment for PTSD or acute stress is greater -- and the number of people sent out of theater for treatment is lower, Barker said.
"We see about 50 patients per month, and we've only had two in two months that we had to send back to Germany because their symptoms didn't improve," Barker said. "The others go back to work with fewer or no symptoms."
Five of six patients at the Air Force Mental Health clinic are Soldiers, Barker said. They typically suffer symptoms such as headaches, insomnia, irritability and anxiety. The mental health clinic relies in part upon psychiatrists with the 1835th Medical Detachment Combat Stress Control Team, an Army Reserve unit based in Denver, to treat patients who have either traumatic brain injury or PTSD.
"Traumatic brain injuries and PTSD have many of the same symptoms," said Army Col. (Dr.) Augustin Gomez, a psychiatrist with the 1835th CSCT who specializes in treating PTSD. "If we suspect an individual has a traumatic brain injury, we screen them and send them to the Air Force clinic. They do a good job with screening, because very few people come over here with traumatic brain injuries."
Common symptoms of PTSD and traumatic brain injury include insomnia and anxiety. Gomez uses therapy, medication and acupuncture to treat his patients, while the Air Force clinic offers relaxation therapy and prescriptions through patients' primary care managers.
"There are a couple of symptoms we really try to tackle -- headaches and insomnia," said Lt. Col. (Dr.) Jim Whitworth, a social worker with the mental health clinic who's deployed from Eglin AFB, Fla. "Insomnia fights the healing process, because resting is the number-one way of healing."
The most important step in healing is seeking continuity of care, Gomez said. Servicemembers shouldn't assume their PTSD has gone away simply because the symptoms have disappeared.
"PTSD is a chronic illness, and they may have a relapse," he said.
Both the Air Force and Army medical teams complimented their counterparts for the successful integration of medical services.
"Post-traumatic stress and traumatic brain injury often go hand in hand -- the same patients can suffer from both following a single event. The 56th MMB focuses on post-traumatic stress, and the Air Force mental health professionals work with mild traumatic brain injuries," Mavity said. "They're working in great partnership to take care of all of these patients' needs on both ends of that spectrum."
"We're very seamlessly integrated," Marzouk said. "We don't think of ourselves as Army or Air Force; we're just another part of a great team."