Meet the War Doctors Saving Our Soldiers' Lives

A new documentary film puts a face—and a price—on battlefield medicine
by Sally Chew

The original inspiration for the new documentary Fighting for Life was a pre-Iraq War threat in Congress to shut down the Uniformed Services University in Bethesda, Md., which has trained one of every four current active-duty military physicians. It’s hard to imagine lawmakers will try that again anytime soon, considering the tens of thousands of Iraq vets who will likely need physical and/or psychological care for decades to come, but director Terry Sanders won’t rest easy. He wants those of us caught up in our own health issues or waiting for the next installment of House to appreciate the brutality and the accomplishments of modern military medicine while getting to know a few of these docs, along with their shrapnel-pocked charges.

Among the latest high-tech advances in battlefield care is the ability to move patients neatly and quickly in mobile hospitals (aka airplanes): Continue reading »

Follow-Up Exams Uncover More Iraq Vets With Emotional Woes

(HealthDay News) -- The number of Iraq war veterans needing mental-health care has risen sharply since the U.S. Defense Department began screening them a second time for emotional problems, U.S. military researchers reported Tuesday.

Initial screenings of veterans uncovered 4.4 percent who needed treatment for problems such as depression or post-traumatic stress disorder (PTSD). But six months later, a second screening found 11.7 percent were in need of mental health care, indicating that it might take several months for emotional disorders to emerge, the study suggested.

"We know mental health problems are a problem for soldiers who have been to war," said lead researcher Dr. Charles S. Milliken, of the Walter Reed Army Institute of Research at the U.S. Army Medical Research and Materiel Command. "We are doing a good thing by having erected these screening programs. Between the two screenings, we are finding a large group of soldiers that are having problems."

The findings are published in the Nov. 14 issue of the Journal of the American Medical Association.

For the study, Milliken and his colleagues collected data on the mental health of 88,235 Iraq war veterans who completed an initial screening and a second screening about six months later. Both screenings included a questionnaire and a short interview with a clinician.

"In the second screening, you do find a larger group of soldiers the first screening completely missed," Milliken said. "It's about twice as big."

The researchers found that more soldiers had mental health problems -- such as PTSD, major depression or alcohol abuse -- during the later screening. In the first screening, 4.4 percent of the soldiers were referred for mental health care, but, after the second screening, 11.7 percent were referred.

Milliken thinks the two-step screening process helps remove the stigma attached to seeking help for emotional problems. "Soldiers are like other young males, they have a stigma about seeking mental health care," he said.

Among all the soldiers screened, 20.3 percent of active duty personnel were referred for mental health care, as were 42.4 percent of reserve soldiers, the study found.

Milliken said he didn't know why the difference exists between the active duty soldiers and the reservists. He speculated, however, that it might have to do with the VA's insurance structure that allows reservists access to free care for service-related health problems.

One expert thinks the new, two-tier system for identifying soldiers with emotional problems is working, but the shear numbers of affected veterans could overburden the VA's health-care system.

"I am not surprised by the rates of PTSD among Iraqi vets," said Dr. Randall Marshall, director of Trauma Studies at the New York State Psychiatric Institute and an associate professor of clinical psychiatry at Columbia University College of Physicians and Surgeons.

Marshall said the difference in PTSD rates among active duty and reserve personnel is expected. "Part of what training is meant to do is desensitize soldiers to all the potential experiences on the battlefield, and the reservists have less training and are therefore more vulnerable to war experiences," he said.

Marshall also said that many reservists have had several tours of duty, "which is something they had not signed up for."

Also, many of these part-time soldiers were split from their units, which means they didn't have as much of a support system as active duty personnel, he said.

Marshall sees another major problem developing for returning veterans. Most psychotherapists aren't trained in the best ways to treat PTSD, he said. "You can't assume because it's a VA hospital everyone there has had this kind of training," he said.

In addition, the number of soldiers needing mental health care is straining an already overburdened system.
"If 20 percent of the veterans realize they need help and start to seek treatment, the system will be overwhelmed. Signs are, it already is," Marshall said.

More information
To learn more, visit the U.S. Department of Veterans Affairs.

MRI Exams Performed Remotely Over the Internet

jk(HealthDay News) -- Radiologists are reporting a successful test of computer software that allows magnetic resonance imaging in one hospital to be controlled over the Internet by a distant expert.
"Some patients require specialized scans that not all technologists are familiar with, so we set up a software program that enables us to run the MRI machine from a remote location," said study lead author Dr. J. Paul Finn, chief of diagnostic cardiovascular imaging at the University of California, Los Angeles, David Geffen School of Medicine.
That test had Finn sitting in his office and controlling an MRI machine that scanned 30 patients a half-mile away at the UCLA Medical Center, while 30 other age-matched people were scanned by a technologist in the hospital. Other radiologists who evaluated the images rated 90 percent of the remote scans as excellent, a mark achieved by only 60 percent of the onsite scans, he said.
UCLA has an agreement with Siemens Medical Solutions to market the technology, but it won't be available for some time, Finn said. Siemens has approval from the U.S. Food and Drug Administration to use the software within one medical center, but it has not yet applied for permission to use it over the Internet, Finn said.
"We're still working on certain aspects of the technology," he added.
When the technology is perfected, Finn sees it being used by smaller hospitals that might not have an MRI technologist familiar with a highly specialized scan of the heart or blood vessels. It could also be used to train technologists to perform such scans, he said.
But Dr. Emanuel Kanal, director of MR services at the University of Pittsburgh, and a spokesman for the Radiological Society of North America, said he saw a number of problems in putting the system to everyday medical use.
One issue is the ego of MRI operators, who insist on being called "technologists" rather than technicians, Kanal said. Some might object to having their machine controlled from a distance, he said.
That's a possible problem, Finn said, but a manageable one. "You need to be sensitive to the local situation," he said. Technologists might welcome the system's ability to give training in specialized scans, he added.
There's also a question of who evaluates the scan, Kanal said. "If the site is not expert in performing a scan, it is not likely to have expertise in interpreting the scan," he said.
Money is another issue, Kanal said. If a scan is done at one facility but is controlled by another facility, who gets paid?
There's no answer yet to that question, Finn said. "Funding is completely up in the air right now," he said. "Potentially, some arrangement could be made. If it will be associated with value, people will pay what they think it is worth."
The technology is open to wider uses, Finn said, such as controlling computerized tomography at a distance, in an emergency situation or even on a battlefield.
Kanal said, "I do like the idea of being able to control remotely. For training purposes, it may have some value. For clinical use, I'm not sure this would be a popular means of execution."
The study findings are published in the November issue of the journal Radiology.
More information
A full explanation of MRI is offered by the National Library of Medicine.

Blood Test Gives Early Warning to Brain Injury

By Megan Rauscher
NEW YORK (Reuters Health) - A new test that detects fragments of broken brain cells that leak into the bloodstream may help doctors quickly detect and treat people with severe head injuries or brain diseases.

"The important thing about this work is that we can easily monitor the release of an axonal protein into serum for the first time," Dr. Gerry Shaw from the University of Florida College of Medicine in Gainesville told Reuters Health.

"It is useful to know this as you can decide whether an accident victim has a serious brain or spinal cord injury quickly without performing MRI, X-rays etc., and you should also be able tell if diseases such as amyotrophic lateral sclerosis, multiple sclerosis, or Alzheimer's are in their early, presymptomatic, stages."

Using their blood test, Shaw and colleagues observed that a brain protein called NF-H is readily detected in "surprisingly large amounts" in the blood of rats following experimentally induced spinal cord injury and, in smaller but still significant amounts, in rats given experimental traumatic brain injury. Since this protein is only found in axons -- nerve fibers that help brain cells communicate -- this indicates that axonal injury must have occurred, Shaw noted.

The discovery, reported in the current online issue of Biochemical and Biophysical Research Communications, could lead to tests for the clinic or battlefield to diagnose ailments with just a few drops of blood, bypassing more cumbersome, time-consuming, and expensive tests such as brain scans.

For example, shaken-soldier syndrome is a traumatic brain injury that can occur when a soldier survives a roadside blast, Dr. Douglas Anderson from the McKnight Brain Institute at the University of Florida who participated in the research explains. "In patients who are unconscious but with no penetrating head wounds, it would be extremely helpful for emergency medical technicians to test for a marker to see how severe the injuries are. Then perhaps something can be done early on," he said in a statement.

SOURCE: Biochemical and Biophysical Research Communications October 2005. More information’s here: