ABSTRACT
As of January, 2012, over 47,430 service members have been wounded in Iraq and Afghanistan. Over half of these wounded service members have been treated and will return to duty within 72 hours; others have not been physically able to return to duty and are sent to the United States for intensive and often prolonged medical care. Many of the casualties result from use of high-energy explosives (Improvised Explosive Devices—IEDs), which are detonated from afar and will blow up military vehicles or derail/overturn the vehicles, harming those within. These IEDs are loaded with shrapnel that cause injuries, often to the extremities. Unique to the history of war for Americans, 90 percent of soldiers wounded who are participating in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), and now Operation New Dawn, will survive their injury. This is due to advances in infection control, body armor and quick evacuation to the United States for care (Hyer, 2006). It is remarkable to note that the average time from battlefield to arrival and care in the United States is now less than four days; in Vietnam it was 45 days (Gawande, 2004). The progress in medical care of the wounded is extraordinary, however it means that more service members return home with grave injuries that can transform their lives. These injuries require extensive levels of care, with soldiers and Veterans needing treatment for many years after their initial injury (Savitsky, Illingworth, & DuLaney, 2009). (NB: Veterans are those in the military who are no longer active duty because of completing their tour of duty and not resigning, retirement, or medical retirement. Soldiers/service members are in the military and are still engaged in active duty.) Another way to understand the impact of these improvements is that for every military personnel killed in these wars, at least 16 wounded will return to the 93United States (Frain, Bethel, & Bishop, 2010); this does not take into account the number of soldiers who return with major mental health diagnoses estimated at over 20 percent of our troops (Hoge, Auchterlonie, & Milliken, 2006; Seal, Bertenthal, Miner, et al., 2007). This huge influx of wounded has created a situation in which the traditional systems of care are taxed and the civilian sector has begun to become engaged in the care of those returning from OEF/OIF.
