OIF/OEF Psychiatric MEDEVACs
Lt Col Monty Baker, PhD (US Air Force)
To conduct a comprehensive review of psychiatric aeromedical evacuations from Iraq and Afghanistan. Determine the long-term impact of those evacuations, identify areas of risk, provide recommendations to improve patient and aircrew safety, and yield data leading to improved care for patients, more efficient utilization of resources, and a reduction in medical discharges.
Aeromedical evacuations of military personnel from combat areas for psychiatric reasons often have negative consequences for the patients as well as for the military. Unstable or misclassified psychiatric patients may be the single greatest threat to aircrew and aircraft safety during an aeromedical evacuation because of an increased likelihood that they will become combative or disorderly. In addition, many of those evacuated do not return to deployed locations and end up leaving the military, ending their careers and eroding the size of deployed forces.
Although 10 percent of the U.S. military aeromedical evacuations out of combat theater in Iraq and Afghanistan since 2001 were for psychiatric reasons, few studies have provided demographic and other descriptive information about those evacuations. And little is known about the short- and long-term military career impact of psychiatric aeromedical evacuations in terms of Medical Evaluation Boards, discharges from active duty, involuntary discharges and other consequences.
The most comprehensive study to date of patients evacuated for psychiatric reasons to Landstuhl Army Medical Center, Germany, found that they were more likely to be younger, enlisted, members of the Reserve or National Guard, and ethnic minorities. Fewer than 5% returned to duty in Iraq/Afghanistan, representing a significant degree of force reduction in theater.
In an effort to learn more about psychiatric medical evacuations from theater and their long-term consequences, investigators have launched a STRONG STAR-affiliated study examining the outcomes of service members evacuated from Iraq and Afghanistan since January 2001.
Leading the investigation are Lt Col Monty Baker, PhD, with Wilford Hall Ambulatory Surgical Center at Joint Base San Antonio-Lackland; Lt Col Alan Peterson, PhD (USAF, Retired) of The University of Texas Health Science Center at San Antonio; and Lt Col Jeffrey Cigrang, PhD (USAF, Retired) of Wright State University. All active duty or retired Air Force psychologists, Drs. Baker, Peterson, and Cigrang and their colleagues are analyzing clinical data of those evacuated for psychiatric reasons to determine their demographic characteristics, their combat experiences, and the incidence of acute stress disorder and posttraumatic stress disorder. They hypothesize that the majority of those evacuated for psychiatric reasons end up being medically discharged or involuntarily separated from active duty.
Investigators believe that study findings will influence recommendations for patient treatment. For instance, if results indicate that the majority of psychiatric patients aeromedically evacuated from the combat theater are medically discharged from active duty, this may highlight the value of treating some patients prior to evacuation. It may also demonstrate a need for increased availability of treatment for combat-related PTSD in deployed locations with evidence-based therapies such as Prolonged Exposure and Cognitive Processing Therapy. Successful treatment of more individuals in-theater would mean fewer career-ending psychiatric evacuations, reduced levels of combat zone force reductions, and fewer psychiatric patients aboard aeromedical evacuation flights.