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This unique volume presents the experience of 37 U.S. military nurses sent to the Iraq and Afghanistan theaters of war to care for the injured and dying. The personal and professional challenges they faced, the difficulties they endured, the dangers they overcame, and the consequences they grappled with are vividly described from deployment to discharge. In mobile surgical field hospitals and fast-forward teams, detainee care centers, base and city hospitals, medevac aircraft, and aeromedical staging units, these nurses cared for their patients with compassion, acumen, and inventiveness. And when they returned home, they dealt with their experience as they could. The text is divided into thematic chapters on essential issues: how the nurses separated from their families and the uncertainties they faced in doing so; their response to horrific injuries that combatants, civilians and children suffered; working and living in Iraq and Afghanistan for extended periods; personal health issues; and what it meant to care for enemy insurgents and detainees. Also discussed is how the experience enhanced their clinical skills, why their adjustment to civilian life was so difficult, and how the war changed them as nurses, citizens, and people.

When soldiers at Fort Carson were charged with a series of 14 murders, PTSD and other \"invisible wounds of war\" were thrown into the national spotlight. With these events as their starting point, Jean Scandlyn and Sarah Hautzinger argue for a new approach to combat stress and trauma, seeing them not just as individual medical pathologies but as fundamentally collective cultural phenomena. Their deep ethnographic research, including unusual access to affected soldiers at Fort Carson, also engaged an extended labyrinth of friends, family, communities, military culture, social services, bureaucracies, the media, and many other layers of society. Through this profound and moving book, they insist that invisible combat injuries are a social challenge demanding collective reconciliation with the post-9/11 wars. Introduction Part I: Coming Home 1. Lethal Warriors at Home 2. \"Best Home Town in the Army\" 3. Doing Dirty Work 4. PTSD = Pulling the Stigma Down 5. Decentering PTSD Part II: The Supporting Cast 6. Codeswitching : \"So, why do you have frostbite?\" 7. \"This is Our Playground\": Family Readiness Groups 8. Waiting to Serve 9. Appropriate Accommodation, or Exceptionalism for Supercitizens? 10. \"This Land is Not for Sale\": Pinon Canyon and Army Expansionism Part III: Dialogue 11. \"You're Not a Victim, You're a Volunteer\" 12. \"Closing the Gaps\": Seeking Civilian-Military Dialogue 13. \"Clueless Civilians\" and Others 14. The Day after Veterans Day: Listening to the Homefront Conclusion: Toward a Collective Reckoning with the Post-9/11 Wars

\"If you consider Iraq-like I do, probably twenty-nine out of thirty days-to be the pinnacle of your life, then where do you go from there? And I'm sure that a lot of veterans feel that way. To them, that was it. That was everything. So now what? They have to find something meaningful and purposeful.\" \"When I got back from Afghanistan, there was not even so much as a briefing that said, 'Let us know if you're having problems.' There wasn't so much as a phone number. There was literally nothing.\" \"I knew it was crazy. I was thinking, the guy on the roof's either a sniper or he's going to radio ahead. And then I thought, this is San Antonio. There's not snipers on the roof, nobody's going to blow me up here.\" \"Whenever I look at people back here at home, I know what they're going to look like dead. I know what they look like with their brains blown out or jaws blown off or eyes pulled out. When I look at somebody I see that, to this day.\" -Voices of veterans interviewed in Fields of Combat For many of the 1.6 million U.S. service members who have served in Iraq and Afghanistan since 2001, the trip home is only the beginning of a longer journey. Many undergo an awkward period of readjustment to civilian life after long deployments. Some veterans may find themselves drinking too much, unable to sleep or waking from unspeakable dreams, lashing out at friends and loved ones. Over time, some will struggle so profoundly that they eventually are diagnosed with post-traumatic stress Disorder (PTSD). Both heartbreaking and hopeful, Fields of Combat tells the story of how American veterans and their families navigate the return home. Following a group of veterans and their personal stories of war, trauma, and recovery, Erin P. Finley illustrates the devastating impact PTSD can have on veterans and their families. Finley sensitively explores issues of substance abuse, failed relationships, domestic violence, and even suicide and also challenges popular ideas of PTSD as incurable and permanently debilitating. Drawing on rich, often searing ethnographic material, Finley examines the cultural, political, and historical influences that shape individual experiences of PTSD and how its sufferers are perceived by the military, medical personnel, and society at large. Despite widespread media coverage and public controversy over the military's response to wounded and traumatized service members, debate continues over how best to provide treatment and compensation for service-related disabilities. Meanwhile, new and highly effective treatments are revolutionizing how the Department of Veterans Affairs (VA) provides trauma care, redefining the way PTSD itself is understood in the process. Carefully and compassionately untangling each of these conflicts, Fields of Combat reveals the very real implications they have for veterans living with PTSD and offers recommendations to improve how we care for this vulnerable but resilient population. For many of the 1.6 million U.S. service members who have served in Iraq and Afghanistan since 2001, the trip home is only the beginning of a longer journey. Many undergo an awkward period of readjustment to civilian life after long deployments. Some veterans may find themselves drinking too much, unable to sleep or waking from unspeakable dreams, lashing out at friends and loved ones. Over time, some will struggle so profoundly that they eventually are diagnosed with post-traumatic stress Disorder (PTSD). Both heartbreaking and hopeful, Fields of Combat tells the story of how American veterans and their families navigate the return home. Following a group of veterans and their their personal stories of war, trauma, and recovery, Erin P. Finley illustrates the devastating impact PTSD can have on veterans and their families. Finley sensitively explores issues of substance abuse, failed relationships, domestic violence, and even suicide and also challenges popular ideas of PTSD as incurable and permanently debilitating. Drawing on rich, often searing ethnographic material, Finley examines the cultural, political, and historical influences that shape individual experiences of PTSD and how its sufferers are perceived by the military, medical personnel, and society at large. Despite widespread media coverage and public controversy over the military's response to wounded and traumatized service members, debate continues over how best to provide treatment and compensation for service-related disabilities. Meanwhile, new and highly effective treatments are revolutionizing how the Department of Veterans Affairs (VA) provides trauma care, redefining the way PTSD itself is understood in the process. Carefully and compassionately untangling each of these conflicts, Fields of Combat reveals the very real implications they have for veterans living with PTSD and offers recommendations to improve how we care for this vulnerable but resilient population.

Partly on the strength of their apparent success in insurgencies such as Malaya and Northern Ireland, the British armed forces have long been perceived as world class, if not world beating. However, their recent performance in Iraq and Afghanistan is widely seen as-at best-disappointing; under British control Basra degenerated into a lawless city riven with internecine violence, while tactical mistakes and strategic incompetence in Helmand Province resulted in heavy civilian and military casualties and a climate of violence and insecurity. In both cases the British were eventually and humiliatingly bailed out by the US army. In this thoughtful and compellingly readable book, Frank Ledwidge examines the British involvement in Iraq and Afghanistan, asking how and why it went so wrong. With the aid of copious research, interviews with senior officers, and his own personal experiences, he looks in detail at the failures of strategic thinking and culture that led to defeat in Britain's latest \"small wars.\" This is an eye-opening analysis of the causes of military failure, and its enormous costs.

Background: A growing body of research on US Veterans from Afghanistan and Iraq [Operations Enduring and Iraqi Freedom, and Operation New Dawn (OEF/OIF)] has described the polytrauma clinical triad (PCT): traumatic brain injury (TBI), posttraumatic stress disorder (PTSD), and pain. Extant research has not explored comorbidity clusters in this population more broadly, particularly co-occurring chronic diseases. Objectives: The aim of the study was to identify comorbidity clusters among diagnoses of deployment-specific (TBI, PTSD, pain) and chronic (eg, hypertension, diabetes) conditions, and to examine the association of these clusters with health care utilization and adverse outcomes. Research Design: This was a retrospective cohort study. Subjects: The cohort comprised OEF/OIF Veterans who received care in the Veterans Health Administration in fiscal years (FY) 2008–2010. Measures: We identified comorbidity using validated ICD-9-CM code–based algorithms and FY08–09 data, followed by which we applied latent class analysis to identify the most statistically distinct and clinically meaningful patterns of comorbidity. We examined the association of these clusters with process measures/outcomes using logistic regression to correlate medication use, acute health care utilization, and adverse outcomes in FY10. Results: In this cohort (N = 191,797), we found 6 comorbidity clusters. Cluster 1: PCT + Chronic Disease (5%); Cluster 2: PCT (9%); Cluster 3: Mental Health + Substance Abuse (24%); Cluster 4: Sleep, Amputation, Chronic Disease (4%); Cluster 5: Pain, Moderate PTSD (6%); and Cluster 6: Relatively Healthy (53%). Subsequent health care utilization patterns and adverse events were consistent with disease patterns. Conclusions: These comorbidity clusters extend beyond the PCT and may be used as a foundation to examine coordination/quality of care and outcomes for OEF/OIF Veterans with different patterns of comorbidity.

Objectives. We sought to investigate longitudinal trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans. Methods. We determined the prevalence and predictors of mental health diagnoses among 289 328 Iraq and Afghanistan veterans entering Veterans Affairs (VA) health care from 2002 to 2008 using national VA data. Results. Of 289 328 Iraq and Afghanistan veterans, 106 726 (36.9%) received mental health diagnoses; 62 929 (21.8%) were diagnosed with posttraumatic stress disorder (PTSD) and 50 432 (17.4%) with depression. Adjusted 2-year prevalence rates of PTSD increased 4 to 7 times after the invasion of Iraq. Active duty veterans younger than 25 years had higher rates of PTSD and alcohol and drug use disorder diagnoses compared with active duty veterans older than 40 years (adjusted relative risk = 2.0 and 4.9, respectively). Women were at higher risk for depression than were men, but men had over twice the risk for drug use disorders. Greater combat exposure was associated with higher risk for PTSD. Conclusions. Mental health diagnoses increased substantially after the start of the Iraq War among specific subgroups of returned veterans entering VA health care. Early targeted interventions may prevent chronic mental illness.

Nearly 1.9 million U.S. troops have been deployed to Afghanistan and Iraq since October 2001. Many service members and veterans face serious challenges in readjusting to normal life after returning home. This initial book presents findings on the most critical challenges, and lays out the blueprint for the second phase of the study to determine how best to meet the needs of returning troops and their families.

ABSTRACT BACKGROUND The changing scope of women’s roles in combat operations has led to growing interest in women’s deployment experiences and post-deployment adjustment. OBJECTIVES To quantify the gender-specific frequency of deployment stressors, including sexual and non-sexual harassment, lack of social support and combat exposure. To quantify gender-specific post-deployment mental health conditions and associations between deployment stressors and posttraumatic stress disorder (PTSD), to inform the care of Veterans returning from the current conflicts. DESIGN National mail survey of OEF/OIF Veterans randomly sampled within gender, with women oversampled. SETTING The community. PARTICIPANTS In total, 1,207 female and 1,137 male Veterans from a roster of all Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans. Response rate was 48.6 %. MAIN MEASURES Deployment stressors (including combat and harassment stress), PTSD, depression, anxiety and alcohol use, all measured via self-report. KEY RESULTS Women were more likely to report sexual harassment (OR = 8.7, 95% CI: 6.9, 11) but less likely to report combat (OR = 0 .62, 95 % CI: 0.50, 0.76). Women and men were equally likely to report symptoms consistent with probable PTSD (OR = 0 .87, 95 % CI: 0.70, 1.1) and symptomatic anxiety (OR  =  1.1, 9 5% CI: 0.86, 1.3). Women were more likely to report probable depression (OR = 1.3, 95 % CI: 1.1, 1.6) and less likely to report problematic alcohol use (OR  = 0 .59, 9 5% CI: 0.47, 0.72). With a five-point change in harassment stress, adjusted odds ratios for PTSD were 1.36 (95 % CI: 1.23, 1.52) for women and 1.38 (95 % CI: 1.19, 1.61) for men. The analogous associations between combat stress and PTSD were 1.31 (95 % CI: 1.24, 1.39) and 1.31 (95 % CI: 1.26, 1.36), respectively. CONCLUSIONS Although there are important gender differences in deployment stressors—including women’s increased risk of interpersonal stressors—and post-deployment adjustment, there are also significant similarities. The post-deployment adjustment of our nation’s growing population of female Veterans seems comparable to that of our nation’s male Veterans.

In this study of injured U.S. military personnel, an advanced MRI technique found abnormalities consistent with traumatic axonal injury in some patients with mild traumatic brain injury after blasts; these abnormalities were not detected with conventional MRI. In the current wars in Iraq and Afghanistan, the number of blast-related traumatic brain injuries may be as high as 320,000. 1 Most of these injuries are categorized as uncomplicated “mild” or “concussive” traumatic brain injury on the basis of clinical criteria and the absence of intracranial abnormalities on computed tomography (CT) or conventional magnetic resonance imaging (MRI). 2 However, little is known about the nature of these “mild” injuries, and the relationship between traumatic brain injury and outcomes remains controversial. 3 , 4 No human autopsy studies conducted with the use of current immunohistochemical methods 5 , 6 have been published. 7 , 8 Computer simulations of . . .