Finding the Practice Gap
As someone whose job is to connect Red Cross programs and services with military organizations in the state, Pepe considered the need for the activity obvious. In a session at the 2012 Alliance for Continuing Education in the Health Professions, she explained that more than 2.1 million men and women have served in Operation Iraqi Freedom and Operation Enduring Freedom in the more than 10 years the U.S. has been at war. Many of these are National Guard and Reserves personnel, who return to civilian jobs when their rotations are completed. Pennsylvania has the largest contingent of National Guardsmen deployed during OIF and OEF—nearly 20,000.
Unlike in previous wars, most injuries incurred by those fighting in Iraq and Afghanistan come from improvised explosive devices and rocket-propelled grenades, which means that more returning military service personnel are coming back with PTSD and TBI than has been the case in the past. In fact, Pepe said, 22 percent of all returning service personnel have some form of TBI, and it’s estimated that one-third of troops suffer from PTSD when they return home.
And yet, particularly in the case of returning Guard and Reserve personnel who are known to their physicians in their civilian roles, when they go see their family doctor about recurring headaches, irritability, insomnia, and other classic symptoms of PTSD and TBI—things that also could have other causes—the doctor may not have the information needed to make the correct diagnosis. “PTSD and TBI have been recognized as common co-morbidities in this population. They’re the silent and often unrecognized signatures of these particular combats,” Pepe said.
Although the American Red Cross provides psychological first aid for military families that includes educational outreach to community healthcare providers and to the families of returning service members, it needed an accredited CME provider to provide the hook—the CME and CE credits—and the programming that would draw in the primary care physicians who most needed the education. So Pepe called Bixler at Penn State’s School of Medicine—which,in addition to being an accredited CME provider that was “practically in her back yard,” also was where Pepe earned her PhD—to develop a symposium that would help primary care and other healthcare providers better recognize and treat returning military service people with PTSD and mild to moderate TBI.