Non-combat Trauma Research Articles

Training in trauma management

Considerable improvements have occurred in the care of injured patients since the times of World War I and II. This has been brought about not only by technological advances but also due to improved training of doctors and nurses in providing trauma care. Important elements of combat trauma training are realism, human-specific injuries and treatments, volume of trauma exposure, and team building. In all modern armies training is imparted using human simulators and mannequins, human cadavers, occasionally live animals but more often using animal tissues. Worldwide trauma training courses are mandatory for both paramedics and medical officers. There is a need to set up an organised system of trauma training in India and we, in the Armed Forces have to capitalize on the wealth of combat and non-combat trauma experience, in setting up such courses.

Case Study of Six-Year Follow-Up of Navy Survivors of a Multiple Fatality Fire at Sea

This case study reports on the mental health of survivors of a multiple fatality fire at sea in an Australian Navy ship. Survivors were screened on three occasions after the fire with the Impact of Events Scale-Revised (IES-R) or Post-Traumatic Check List-Civilian version (PCL-C), and once with the General Health Questionnaire, 28-Item version (GHQ-28), and the Alcohol Use Disorders Identification Test (AUDIT). Rates of possible disorders are discussed, along with comparisons with similar samples, and stability of possible post-traumatic stress disorder (PTSD) over time. While limited in size, the sample of this study contributes to the relatively small body of literature regarding the course of posttraumatic mental health in military personnel exposed to noncombat trauma.

Infectious Complications of Noncombat Trauma Patients Provided Care at a Military Trauma Center

Infectious complications are reported frequently in combat trauma patients treated at military hospitals. Infections in 4566 noncombat related trauma patients treated at a military trauma center were retrospectively reviewed from 1/2003 to 5/2007 using registry data. Burns, penetrating, and blunt trauma accounted for 17%, 19%, and 64%, respectively; the median age was 38 and 22% were female. Pulmonary infections were present in 4.2% of patients, 2.4% had cellulitis and wound infections, 2.2% urinary infections, and 0.7% sepsis. On univariate analysis, infected patients were more likely to be admitted to the ICU, have longer ICU and hospital lengths of stay (LOS), and to die (p < 0.05). Multivariate analysis revealed associations between infection and hospital LOS, preexisting medical conditions, and lower Glasgow Coma Scale in nonburned patients. In burned patients, infection was associated with total body surface area burned and preexisting conditions (p < 0.01). Enhanced infection control in targeted trauma populations may improve outcomes.

Neurobiology of Posttraumatic Stress Disorder

Recent advances on the neurobiology of posttraumatic stress disorder include: the utilization of functional brain imaging; the incorporation of cross-system research including neuroendocrine (hypothalamic-pituitary-adrenal and hypothalamic-pituitary-thyroid axes), neurochemical (corticotropin-releasing factor, norepinephrine, serotonin, endogenous opiates), and neuroimmunological (humoral and cellular immunity) systems; the expansion beyond exclusive study of combat veterans to include posttraumatic stress disorder patients suffering from noncombat traumas; and the development of animal models of traumatic stress.

Do schizotypal factors reflect the associations found between symptom syndromes and cognitive deficits in schizophrenia?

The present study examined lifespan and combat-related trauma exposure as predictors of alcohol use among male and female veterans. Posttraumatic stress and depressive symptoms were examined as mediators of the effects of trauma exposure on alcohol use.Data were examined from 1825 (1450 male, 375 female) veterans and active duty service members who took part in a multi-site research study conducted through the Department of Veterans Affairs Mid-Atlantic Mental Illness Research, Education and Clinical Center (VISN 6 MIRECC).For both men and women, depressive symptoms significantly mediated the effects of non-combat trauma exposure experienced before, during and after the military, as well as combat-exposure, on alcohol use. With posttraumatic stress symptoms, the models for men and women differed. For men, the effects of non-combat trauma exposure during and after military service, and combat exposure, on alcohol use were mediated by PTSD symptoms; however, for women, PTSD symptoms did not mediate these relationships.Findings are discussed in the context of potential gender differences in response to trauma such as use of alcohol to cope with traumatic events.

The psychiatric sequelae of civilian trauma

Much of the literature on the psychiatric consequences of stress has focused on wartime combat trauma. However, traumatic events also frequently occur in civilian life. Controlled studies on the psychiatric effects of noncombat trauma were reviewed and a meta-analysis of these data was conducted. Generalized anxiety disorder (GAD), posttraumatic stress disorder (PTSD), substance abuse, phobia, and major depressive disorder (MDD) were significantly elevated compared with a pooled control group, whereas panic disorder and dysthymic disorder were not significantly increased. These data suggest that the psychiatric effects of civilian trauma include both anxiety and depressive disorders. The results are strikingly similar to those reported in combat veterans, suggesting that severe trauma, even in very different populations, may be associated with similar psychopathology.

Relationship between symptom over-reporting and pre- and post-combat trauma history in veterans evaluated for PTSD.

We examined the prevalence of pre- and post-combat traumatic events in the histories of 129 combat veterans referred to be evaluated for PTSD and examined the impact of these non-combat traumatic events on self-reported psychiatric symptoms. Participants were consecutive referrals to a Veterans Affairs outpatient post-traumatic stress disorder (PTSD) clinic who completed structured interviews, self-report measures (e.g., Minnesota Multiphasic Personality Inventory-2; MMPI-2), and a trauma history questionnaire as part of their routine clinical evaluations. Findings show that non-combat trauma was prevalent in this sample, with 65% (21% pre-combat) reporting physical assaults and 12% (11% pre-combat) reporting sexual assaults. Overall, history of sexual or physical assaults did not appear to be systematically related to reported symptom level. However, chi square analyses revealed a consistent over-representation of veterans who reported sexual trauma in the category suggestive of response exaggeration (i.e., MMPI-2 F-K validity index > or = 13). Finally, a hierarchical regression equation predicting F-K scores was computed, but accounted for only 15.9% of the variance in F-K. Presence of sexual assault history was the only predictor associated with a more pronounced response set suggestive of exaggeration or deception. These findings tentatively indicate that if history of sexual or physical assault has an impact on symptom reporting in combat veterans evaluated for PTSD, it is of modest magnitude.

Traumatogenicity: Effects of self-reported noncombat trauma on MMPIs of male Vietnam combat and noncombat veterans treated for substance abuse

A recent review of the literature on Post-Traumatic Stress Disorder (PTSD) and the MMPI has shown that all previously published studies have been limited to clinical groups whose trauma occurred in Vietnam combat. The purpose of this study was to test hypotheses that predict higher MMPI and PTSD scale scores among combat veterans who differ in degrees of noncombat traumas. Results support predictions. Those who reported more noncombat traumas attain significantly higher MMPI scores for scales F, Hypochondriasis, Hysteria, Psychopathic Deviate, Psychasthenia, Schizophrenia, Mania, Social Introversion, and an MMPI PTSD score (Keane, Malloy, & Fairbank, 1984). Moreover, noncombat effects are manifested differentially: Combat veterans with higher noncombat trauma evidence greater social withdrawal, whereas noncombat veterans who report higher noncombat trauma are characterized by higher anxiety. MMPI elevations were progressively higher as groups increased in degrees of combat and noncombat trauma: noncombat and low combat trauma veterans were the better adjusted, and combat veterans with higher noncombat trauma were the worst adjusted. Results provide descriptive validity for PTSD as a construct and underscore the importance of assessing frequency and intensity, as well as types of traumas and stresses, in the background histories of substance abusers and other clinical groups as well.