Philip Larson, Military Veterans Director at the University of Michigan presents on the visible and invisible wounds experienced by today's veterans.

1. The Visible and Invisible
Wounds of Today’s Veterans
Philip Larson
U-M Veteran and Military Services

2. Disclaimers
• This presentation may be a trigger for those
who have experienced combat
• This is heavy material
• Some of what I will say and discuss may
disturbing
• I am not a doctor, clinician, social worker or
therapist
• I have never served in combat

3. Brief History of Injuries in Combat
• WWI – trench foot, gas, lice, shell shock
– 4% survival rate
• WWII – artillery/bombs, malaria
– 69.7% survival rate
• Korea – cold weather, agent orange
– 75.4% survival rate
• Vietnam – agent orange, environmental
– 86.5% survival rate
• Gulf War – Chemical/Biologic, Immunizations
• Today
– 90% survival rate

4. Iraq (OIF) Afghanistan
• Iraq War (OIF) 2003-2011
– Modern Country, Cities,
Roads/Highways
– Urban warfare, Countryside,
IEDs
• Afghanistan War (OEF)
2001 - Present
– Mountainous, some cities
– Rural Insurgency

5. Combat Trauma
• Physical Visible
• Physical Hidden
• Psychological Visible
• Psychological Hidden

6. IED
• http://www.youtube.com/watch?v=XLR127_I9sw
• http://www.youtube.com/watch?v=rNx3-R13FtA

7. IED Wounds
• Roadside and footpath blasts
• Limb loss – 11% lost more than one limb
• Genital injuries
– (often combined with double amputation of legs)
• Shrapnel wounds
• Burns
• TBI
• Psychological Trauma

8. Sniper Fire
• High velocity rounds
• Head and Neck wounds
• Psychological Trauma

9. Combat
http://www.youtube.com/watch?v=b9Pq5JZ2Fd8 (6:07 – 12:00)
• Explosive devices/rounds
• Non-explosive rounds
• Rocket propelled grenades
• Shoot downs
• Friendly Fire
• Psychological Trauma

10. Accidents
• Aviation
• Ground
• Transportation to battlefield
• Accidents
• Faulty equipment

11. TBI
• Caused by sudden trauma to the head or a
penetrating head injury, that disrupts the
normal functioning of the brain.
• Blasts are leading cause in combat zones
• Person may remain conscious or be dazed or
confused after injury takes place
• Symptoms are subtle and may not occur for
days or weeks following the injury.

12. TBI
• Mild TBI
– Headaches or neck pain that does not go away.
– Light-headedness, dizziness or loss of balance.
– Urge to vomit (nausea).
– Loss of sense of smell or taste.
– Ringing in the ears.
– Difficulty remembering, concentrating or making decisions.
– Slowness in thinking, speaking, acting or reading.
– Getting lost or easily confused.
– Feeling tired all of the time and having no energy or motivation.
– Mood changes (feeling sad or angry for no reason).
– Changes in sleep patterns (sleeping a lot more or having a hard time sleeping).
– Increased sensitivity to lights, sounds or distractions.
– Blurred vision or eyes that tire easily.

13. TBI
• Severe TBI
• Headache that gets worse or does not go away.
• Repeated vomiting or nausea.
• Convulsions or seizures.
• Inability to awaken from sleep.
• Dilation of one or both pupils of the eyes.
• Slurred speech.
• Weakness or numbness in the extremities.
• Loss of coordination.
• Increased confusion, restlessness or agitation.3

14. TBI
• Compounding issues
– Delay in treatment
– Repeated concussive events
• Increases risk of
– Alzheimer’s Disease
– Parkinson’s Disease
– Dementia

15. TBI
• Diagnosis
– Military Acute Concussion Evaluation
– CT Scan
– MRI
– Single Emission Computed Tomography
– Positron Emission Tomography
– Cognitive Evaluations
– Physical, Occupational and Speech Evaluations

16. Psychological
• 2012 SVA Survey:
0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%
Severe Anxiety
Severe Depressive Symptoms
Significant PTSD symptoms
Thoughts about suicide

17. Stories
• Fallujah family home
• Convoy Duty
• M1 Tank

18. PTSD
• Experience or witness of an event that
involved actual or threatened death or injury
• Response involves intense fear, helplessness
or horror
• Moral injury
• Can be acute or chronic

19. PTSD
Re-experience the event
• Recurrent and intrusive recollection of the
event
– Images, thoughts, perceptions
• Dreams
• Act as though the event was recurring
• Reaction to “triggers”

20. PTSD
• Responses
– Avoidance
• Thoughts, feelings, conversations
• Activities, places, people
– Inability to recall event or pieces of event
– Feeling of detachment
– Restricted emotions
– Inability to look ahead
– Shame, Guilt, Loss

21. PTSD
• Physical arousal
– Difficulty falling or staying asleep
– Irritability or outbursts of anger
– Difficulty concentrating
– Hypervigilance
– Exaggerated startle response

22. PTSD
• Treatment
– Safety and Security
– Telling the story
• talking, art, writing, acting
– Remembering
– Dealing with the moral injury
– Managing Triggers
– Sleep management
– Concentration
– Emotional management

23. From a veteran’s perspective
(ten things you should know about todays student veteran)
• Student Veterans are a highly diverse group
• Veterans do not see themselves as victims, ever!
• They can feel alone on campus
• They are often unaware of their PTSD or TBI
• There are three things you should never say to a
veteran but they still hear them every day
– These wars were atrocities and a waste of human life.
– I don’t understand what you’re having trouble – you
volunteered for service.
– Did you kill anyone?

24. Veteran’s perspective cont.
• Female soldiers suffer in silence
– 15% of military
– 22% of whom will be sexually assaulted during their
military service
• They often want to go back to the war zone
• Combat trauma is an injury not a mental illness
• Veterans need your understanding, compassion and
respect
• Student Veterans are one of America’s greatest
untapped human resources

25. Documentaries
• The Battle for Marjah
• Restrepo
• Korengal
http://www.youtube.com/watch?v=jw_anreJjow&list=PLHQ5K79eN3JSQEpnE
pDavx5ziqkrWY2cD

26. References
• http://www.bbc.co.uk/schools/0/ww1/25403864 - WWI Injuries
• http://www.netplaces.com/world-war-ii/the-horrors-of-war/battlefield-
injuries-and-medicine.htm - WWII injuries
• http://www.va.gov/oaa/pocketcard/korea.asp - Korea injuries
• http://www.federallabs.org/news/top-stories/articles/?pt=top-
stories/articles/0609-03.jsp - survival rates
• http://www.nea.org/home/53407.htm - Ten Things You Should Know
About Today’s Student Veteran
• http://www.realwarriors.net/active/treatment/tbisigns.php - TBI signs
and symptoms
• University of Michigan P.A.V.E program – SVA statistics
• Williams, Mary Beth, Ph.D., LCSW, CTS & Poijula, Soili, Ph.D. (2002) . The
PTSD Workbook, Oakland, CA, New Harbinger Publications