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From Combat to Classroom: Transitions of Modern Warriors. Cari Myles, MSW, LCSW OEF/OIF Outreach Coordinator Wm S. Middleton Memorial Veterans’ Hospital, Madison, WI. The Global War on Terrorism Operation Enduring Freedom (OEF) Operation Iraqi Freedom (OIF). Operation Enduring Freedom.

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From Combat to Classroom: Transitions of Modern Warriors

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From combat to classroom transitions of modern warriors l.jpg

From Combat to Classroom: Transitions of Modern Warriors

Cari Myles, MSW, LCSW

OEF/OIF Outreach Coordinator

Wm S. Middleton Memorial

Veterans’ Hospital, Madison, WI


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The Global War on TerrorismOperation Enduring Freedom (OEF)Operation Iraqi Freedom (OIF)

Operation Enduring Freedom

Operation Iraqi Freedom


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The Veterans Administration OEF/OIF Returning Combat Veteran Program


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OEF/OIF Transition to VHA Services


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VA/DoD Polytrauma System of Care


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Here’s some numbers…

  • Operation Iraqi Freedom (OIF) as of Nov 6, 2008

    • Total deployed:

    • Total Deaths: 4,193

    • Wounded in Action, Returned to Duty within 72 hours 17,2178

    • Wounded in Action, NOT Returned to Duty within 72 hours 13,556

  • Operation Enduring Freedom (OEF) as of Nov 6, 2008

    • Total deployed:

    • Total deaths: 622

    • Wounded in Action, Returned to Duty within 72 hours 911

    • Wounded in Action, NOT Returned to Duty within 72 hours 1, 670

  • Wisconsin Numbers:

    • Since Sept 11, 2001 over 8,000 Wisconsin National Guard and Air National Guard called to active duty (not all to combat zone)

    • OEF/OIF veterans in Wisconsin

    • Upcoming Wisconsin National Guard will deploy over 3,500 Soldiers to OEF/OIF

    • FY 2008: 6,120 OEF/OIF veterans “unique users” at Madison, Milwaukee or Tomah VAMC’s

11, 222 & 9962


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More numbers….

Veteran’s Health AdministrationNational – (VISN 12)

  • Total Unique OEF/OIF vets FY 08: 260,741 (10,783)

  • Total VA Unique: 5,425, 126 (246,755)

  • % OEF/OIF workload: 4.8% (4.4%)

  • # of OEF/OIF Mental Health Encounters: 889,913 (39,437)

  • All other encounters: 2,456,099(105,807)

  • Total OEF/OIF encounters: 3,346,012 (145,244)

  • Encounters per Unique OEF/OIF vet: 12.4 (12.9)

  • Women in Combat


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Continuing numbers…

  • Approximately 1.6 million deployed, more than 1/3 more than once.

  • 40% of troops and veterans are National Guard/Reservists

  • Due to equipment and immediate medical care, 90% of wounded survive; twice as many require amputations than in previous wars

  • Proximity to blasts have made TBI the “signature injury” ~ 20%

  • Hearing damage is #1 disability

  • One third to one half report psychological problems

  • 18% of veterans recently back are unemployed; of those working 25% earn less than $21,000/year.


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OEF/OIF – Common ComplaintsAches and pains

  • Muscular/Skeletal Injuries

    Armor is heavy 75-125 #


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Common Complaints…Aches and Pains

  • Hot, Dusty, Dirty, Bugs…..


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Common Complaints…Aches and Pains

  • The terrain is tough…


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Common Complaints…Ringing in the ears…hearing loss

  • Military Training and Combat Zone is Noisy –

    tinnitus and hearing loss…


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Common Complaints…Can’t sleep, numb, anxious

Trauma, loss, Readjustment….

“People say I’ve changed...I used to be social, now I’m not; I have anger management problems; I don’t sleep good.”

“I’ve been home for a year now and I’m tired of everyone being worried about me. I get drunk often and everyone is scared.”

“It destroyed 2 marriages; I snap at family; it’s better for everyone if I just stay away.”


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Common Complaints…on alert, sad, “who am I?”

The war is physically harsh, mentally demanding and dangerous. The enemy wears no uniform, uses innocent civilians, and strikes without warning with the intent to kill and terrorize.

“The war…remains very personal”


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Common Complaints…Can’t remember, get lost, headaches

Blast Injuries – TBI

Blast injuries are injuries that result from the complex pressure wave generated by an explosion. The explosion causes an instantaneous rise in pressure over atmospheric pressure that creates a blast over pressurization wave. Primary blast injury occurs from an interaction of the over pressurization wave and the body with differences occurring from one organ system to another. Air-filled organs such as the ear, lung, and gastrointestinal tract and organs surrounded by fluid-filled cavities such as the brain and spinal are especially susceptible to primary blast injury (Elsayed, 1997;Mayorga, 1997). The over pressurization wave dissipates quickly, causing the greatest risk of injury to those closest to the explosion. In a blast, brain injuries can also occur by other means such as impact from blast-energized debris, the individual being physically thrown, burns and/or inhalation of gases and vapors. Blast injuries can be multiple and complex and can often not be assessed in the same manner that other brain injuries might be examined. A better approach to take in evaluating a brain injury caused by a blast may, therefore, be to conduct the evaluation based on the mechanism (cause) of the injury.Defense and Veterans Brain Injury Center


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Common Complaints..Blast Injuries

Exposed to eight different explosions, four not "too terribly serious" but four "marked his vehicle". A couple of events, he does not recall whether or not he was knocked unconscious. Some confusion after one of the events; does not have anterograde memory after some of the events for unspecified amount of time.

A couple other explosions got a headache, tinnitus and "wind knocked out of him." In a couple of them, he was wearing a helmet. Most of these events didn't worry him until he started loosing directional sense, "I started loosing the map in my head".

The veteran was wounded in combat….his Humvee was hit by an IED and he was blown out of the vehicle.. He was then shot at by snipers as he tried to get back to the vehicle and he returned fire

for 30 minutes. The veteran received injuries from the IED attack/ambush. He

was hospitalized initially for 6 days and then was in Germany for 6-7 days and

then was treated at the National Naval Medical Center, Bethesda for 7 months on

and off. He stated that during this attack there were 4

wounded but no killed. He stated that his job in the military as a scout team

leader was to "find IEDs before the convoy, 7 blasts to my vehicle, driving

veteran's vehicle was hit by an IED as part of the convoy scout team. He was

point. All of the attraction was to us. Four hundred plus convoys, small arms

fire all the time."


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Adjusting to life after war…

The Good News is that most are doing well (80%)!!

The Transition from Battlemind to Home:

Training for war includes preparing the soldier mentally –

Self Confidence – taking calculated risks and handling challenges

Mental Toughness – overcoming setbacks and maintaining positive thoughts during times of adversity and challenge

…..The Battlemind Walter Reed Institute of Research


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Returning HomeBattlemind

Buddies vs. Withdrawal

Accountability vs. Controlling

Targeted Aggression vs. Inappropriate Aggression

Tactical Awareness vs. Hypervigiliance


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Returning Home – BattlemindWalter Reed Institute of Research

Lethally Armed vs. “Locked and Loaded” at home

Emotional Control vs. Anger/Detachment

Mission Operational Security vs. Secretiveness


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Battlemind – Returning HomeWalter Reed Institute of Research

Individual Responsibility vs. Guilt

Non-defensive (combat) driving vs. Aggressive Driving

Discipline and Ordering vs. Conflict


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Returning to School

Trying to “melt” into student populations but with..

Exceptionally different experiences

Common physical and emotional complaints sometimes on powerful medication

Many with problems with concentration, memory, irritability, lack of sleep, hypervigiliance

Little to no knowledge of “Disability Resources” on campus


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How to Help?

Don’t single them out, ask if they want vet status to be known.

“Most think I lost my arm in a farming accident, I don’t bother to tell them…”

“I don’t want to ‘get into it’ so I just act like I’ve always been this way.”

“I do OK until the discussion is about the war, then I just don’t say anything.”

Discuss privately what you can offer them.

Like most students with disabilities but perhaps more so, as “Warriors”, do not want special services and probably won’t seek out.

Show interest, understand that “trust has to be earned”.


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How to help…

Connect them with Veteran’s services

Connect with other Vets (if they want)

Connect with other students

Understand the richness their experiences brings to the campus

May be “heroes” but they are “ordinary”…


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Ordinary American Heroes


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Ordinary American Heroes


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Ordinary American Heroes


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Ordinary American Heroes


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Ordinary American Heroes


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Ordinary American Heroes….


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Thank you for supporting our country’s newest veterans!

Cari Myles, MSW, LCSW

OEF/OIF Outreach Coordinator

Wm. S. Middleton Memorial Veteran’s Hospital

Madison, Wisconsin 53705

(608) 256-1901 ext 11297

[email protected]


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