February 3, 2006
Houston unit is among those that will treat multiple injuries under one roof.
By ROSANNA RUIZ
The pervasive use of improvised explosive devices and other weaponry in Iraq and Afghanistan has produced a new medical approach: polytrauma care, a term coined for the head trauma, severed limbs, hearing and vision loss, and other injuries that U.S. troops are suffering in numbers not seen before.
The Department of Veterans Affairs already has created four primary polytrauma rehabilitation centers in the United States to provide integrated care for troops suffering severe injuries and the multiple complications that can result.
The VA is dramatically expanding that effort with a series of 17 "Level II" units across the nation, including one in Houston that will be in operation by the end of next month. The centers concentrate medical specialists, physical therapists and counselors in a one-stop care setting.
Treatment plans in place
After patients complete their treatment at the primary centers - in California, Minnesota, Virginia and Florida - they will be sent to the Level II facilities nearest their homes with a treatment plan already worked out, said Dr. Harriet Zeiner, a clinical neuropsychologist at the VA's polytrauma unit in Palo Alto, Calif.
"The idea is to try to keep up with the integration of treatment," Zeiner said. "The Level IIs are not responsible for coming up with the treatment evaluation, they are responsible for carrying it out."
The Houston VA center received $408,000 in federal money, primarily to hire more therapists. The other Level II centers will be in Dallas, Seattle, Boston and elsewhere. The Level II centers will have about half the staff of the four primary polytrauma units, and most of the treatment will be outpatient.
"This is an exceptional medical center, and to be able to put these patients together is an honor," said Dr. Thomas A. Kent, who is in charge of neurology care at the Houston VA hospital.
Though protective Kevlar helmets and body armor improve troops' chances for survival, they leave areas of the face and neck exposed. That exposure, and the force of the blast itself, often produce internal, or closed head, injuries.
These injuries outnumber penetrating wounds, such as those from a gunshot or shrapnel, among patients treated at Walter Reed Army Medical Center in Washington, D.C., where 450 traumatic brain injuries were treated between January 2003 and February 2005, according to a New England Journal of Medicine article published last year.
With better medical treatment in the field, U.S. troops in Iraq and Afghanistan are more likely to survive traumatic brain injuries than they were in past wars. At the Landstuhl Regional Medical Center in Germany, 22 percent of the wounded troops treated there had head, face or neck injuries, according to the Journal of Medicine.
By comparison, 12 percent to 14 percent of U.S. combat casualties during the Vietnam War had brain injuries while an additional 2 percent to 4 percent had a brain injury plus a severe chest or stomach wound.
"The injuries are different than prior wars," said Dr. Helene K. Henson, rehabilitative care chief at the Houston VA hospital. "And we are just beginning to see that and understand that."
As of Thursday, 2,247 U.S. troops had died since the war in Iraq began in 2003. Of 16,606 wounded in action during that time, 7,257 were listed as unable to return to duty within 72 hours.
Zeiner said that 68 percent of the troops injured in the war were hit by improvised explosive devices, and 60 percent suffered head injuries.
Zeiner is concerned that many are relieved of duty before all their medical problems, such as brain injuries, are diagnosed. She noted that the four lead centers have treated only about 800 people.
Those with brain injuries have headaches, sleep problems, sensitivity to light and noise as well as problems with memory, attention or language. These injuries can lead to behavioral issues similar to post-traumatic stress disorder. Some veterans are particularly at risk for going untreated because some brain injuries are not as apparent as ones that leave physical wounds, Henson said.
My biggest concern is those patients with mild to moderate head injuries that may not be more visible. Some head injuries are often invisible diseases," Henson said. "They are literally walking wounded, and they, in many cases, will be able to walk and speak to you. But their memory is not good, they lose their temper, they are no longer loving and caring with their family, and they get into trouble with the law.
"It's those types of patients we want to be sure we take care of."
The local VA will set aside six beds for long-term hospital care for polytrauma patients. Most of the injured will be treated as outpatients, Henson said.
"Over time, it will be very costly to care for these types of patients over their lifespan, which is essentially our task," Henson said. "We have very young guys and gals coming back with severe injuries that will likely have some lifelong effect. ... The cost is still anybody's guess."