Overseas conflicts and disasters: the challenge of caring for those who serve
Lieutenant General Peter Leahy, former Chief of Army, Australian Defence Force
Major General Professor Jeffrey Rosenfeld, and immediate past ADF-Reserves Surgeon General
Commodore Duncan Wallace, Psychiatrist, ADF Centre for Mental Health
The AMA National Conference has called for better care for Australian Defence Force (ADF) personnel and veterans, including improved coordination between Government agencies, health services and doctors, and research to identify emerging health issues.
The National Conference unanimously supported a motion committing the AMA to develop a policy to improve the health and wellbeing of Defence Force personnel and veterans following presentations from former Chief of Army Lieutenant General Peter Leahy, Navy psychiatrist Commodore Duncan Wallace and immediate past ADF-Reserves Surgeon General, Major General Professor Jeffrey Rosenfeld.
Lieutenant General Leahy, Major General Professor Rosenfeld and Commodore Wallace spoke at the Conference’s Overseas Conflicts and Disasters: the challenge of caring for those who serve session, chaired by new AMA President Associate Professor Brian Owler.
The Conference was told that, since 1999, more than 45,000 members of the ADF had served overseas, with almost half undergoing multiple deployments.
AMA President Associate Professor Brian Owler said many had paid a heavy price for their devotion to their duty.
“Members of our armed forces put themselves in harm’s way on a daily basis, facing risks to both their physical and mental health,” the AMA President said. “Doctors have a proud history of caring for our servicemen and women, and we want to improve the care they receive.”
Commodore Wallace told the Conference that in Afghanistan alone, 40 Defence personnel were killed and more than 260 wounded in action, including seven who suffered traumatic limb amputations and 38 cases where traumatic brain injury was the primary diagnosis.
Lieutenant General Leahy, who is Chair of the Soldier On charity, said changes in the nature of conflict and improvements in medical care meant that many soldiers were surviving wounds that would once have proven fatal.
As a consequence, he said, they were returning home with much more severe injuries, including amputations, fractures, hearing loss, traumatic brain injuries and multiple severe wounds.
Major General Professor Jeffrey Rosenfeld detailed to the Conference just how severe these injuries could be, particularly the prevalence of bomb blast injuries as a result of improvised explosive device attacks.
“Bomb blasts are very severe injuries, the worst I have seen,” he said. “The thing about these injuries is that they are a triad of trauma, including the blast wave effect hat damages internal organs, the penetration of fragments from the bomb, and then the heat effects from the hot air blast causes burns.”
Major General Professor Jeffrey Rosenfeld said advances in training, technology and resources meant many soldiers survived severe injuries.
He said medic training was focused around the importance of providing effect care in the first five minutes following trauma (referred to as ‘Platinum Five’).
He said experience in Afghanistan and Iraq had seen the re-emergence of tourniquets as a life-saving tool, because “what is killing wounded soldiers is bleeding”.
Major General Professor Jeffrey Rosenfeld said all soldiers carried a tourniquet, and it had saved many lives.
But he admitted trauma care was only part of the story.
“It is not just what happens in Afghanistan,” he said. “It is clearly what happens back home [as well].”
Commodore Wallace said that, in addition to their physical wounds, many personnel suffered mental health problems as a result of their service.
He said research showed anxiety disorders were more common among ADF members than the broader community.
In 2010, the 12-month prevalence of all anxiety disorders was 14.8 per cent in ADF members, compared with 12.6 per cent among the general population.
Unsurprisingly, post-traumatic stress disorder was much more common among Defence personnel. The 12-month prevalence of PTSD among ADF members was 8.3 per cent, compared with 5.2 per cent in the broader population, and the incidence of obsessive-compulsive disorder among ADF personnel was more than twice that of Australians in general.
Commodore Wallace said the extent of depressive disorders among ADF personnel was particularly marked – a 6.4 per cent it was more than twice that in the general population.
The speakers told the Conference that one of the biggest problems was getting returned Defence personnel with mental health issues to admit they had a problem and seek help.
Lieutenant General Leahy said among soldiers there was a stigma attached to admitting they had a mental health problem, and Commodore Wallace cited research showing that almost 37 per cent delayed seeking help because they feared it would prevent them from being redeployed, 27 per cent felt such an admission would harm their career prospects, 27 per cent were concerned others would treat them differently, and 25 per cent thought it would make them seem weak.
In his book Exit Wounds, retired Major General John Cantwell wrote that although much had been done by the ADF in recent years to address mental health and promote awareness of the problem, “much of the target audience isn’t listening, or can’t bring themselves to admit that the message is aimed at them”.
Commodore Wallace said the ADF provided a range of services and support, but noted the rehabilitation success rate was higher for personnel with physical injury (72 per cent return to work) as opposed to mental health problems (40 per cent).
Lieutenant General Leahy said that for many soldiers, the transition out of the ADF was particularly difficult and problematic.
He said that despite improvements in recent years, there remained problems for soldiers leaving the ADF to access Department of Veterans’ Affairs services, and there was a lack of support for the families of returned servicemen and women during what could be a difficult transition to civilian life.
Associate Professor Owler said many returned from overseas service with multiple co-morbidities and complex care needs, providing a challenge for carers and health services.
“The medical profession has shown an enormous commitment to the care of ADF personnel and veterans over many years.
“Many doctors have and are serving in the ADF, or are part of the framework of health services put in place by the ADF and the Department of Veterans’ Affairs.
“But things can be done better, and the AMA is keen to work with the ADF, the Department of Veterans’ Affairs and personnel and veterans themselves on ways to improve the delivery and integration of services, so that all get the care they need.”
The resolution passed by the AMA National Conference has called for the development of AMA policy in a number of key areas:
· research to monitor the health of ADF personnel and veterans injured during ADF operations, to identify emerging health issues and better inform the future delivery of health services;
· arrangements for seamless health care delivery to ADF personnel and veterans, including the relationship between the Department of Veterans’ Affairs (DVA), ADF health services and other health care providers;
· the development of a unique service/veteran health identifier to improve the coordination of health care for ADF personnel move across to either DVA health care arrangements or Federal/State funded services; and
· exploring the potential to expand existing non-liability health care arrangements for veterans to a broader range of conditions beyond those currently identified.
Adelaide surgeon Dr Susan Nuehas, who moved the motion, said the draw-down of troops serving overseas, particularly in the Middle East, presented a unique opportunity for the nation to get the treatment of its veterans right.
“We have an opportunity not to repeat the mistakes of the past,” Dr Nuehas said. “This is a rare opportunity in health care, and it is important that the AMA has policies formulated to ensure that veterans get clear, comprehensive care.”