Home From Iraq: Acinetobacter Baumannii

Steve Silberman over at Wired reported quite a story in February, 2007: The Invisible Enemy. Advances in trauma care and frontline medicine is saving lives in Iraq. Injured troops are transported to the largest American military hospital in Europe - Landstuhl Regional Medical Center in Germany. After being stabilized there, the injured are evacuated to the US to recuperate - and the survival rate for this war is 9:10.

Lurking in battle wounds is a lethal pathogen that is the defeat of many of these survivors - an opportunistic pathogen, the multiple drug-resistant acinetobacter baumannii. Mr. Silberman reported 700 US military deaths from the pathogen, now the bacteria has invaded civilian community hospitals. "It preys on the weakest of the weak and the sickest of the sick...slipping into the body through open wounds, catheters, and breathing tubes...it doesn't get a lot of respect because it's not...bumping off normal, healthy, people..." Investigators have concluded that the state-of-the-art medical centers themselves are breeding grounds for the superbugs, and the actual source of contamination - not Iraq and unsanitary conditions or the soil or rainwater or any other ideas.

Independent contractors like Merlin Clark are not immune. His wife Marcie created the website, www.acinetobacter.org. A. Baumannii isn't the only superbug we need to worry about. There is a case of a soldier stationed in Germany who died of epiglotitis due to a bacterial infection. Methicilin-resistant Staphylococcus aureus (MRSA)producing the toxin Panton-Valentine leukocidin(PVL) is another. Leishmaniasis is plaguing Afghanistan. Plus a newly recognized Bartonella species, Pseudomonas aeruginosa, and Klebsiella pneumoniae.

Three years ago, in July 2004, the Infectious Diseases Society of America (IDSA) sent a white paper, Bad Bugs, No Drugs: As Antibiotic Discovery Stagnates...A Public Health Crisis Brews to Congress. They want a Commission to Prioritize Antimicrobial Discovery. They want "wild-card patent extension". They want new funding for antibiotic R&D. They keep telling us resistance to the antimicrobials is on the rise. They report the Acinetobacter problem in soldiers and civilians stationed in Iraq right in the paper(p13). The IDSA reports problems with Salmonellosis, tuberculosis, MRSA in athletes, the economic burden of these problems, the lack of interest in antibiotic research by pharmaceutical companies (5 new antibiotics of 506 new drugs in the pipeline), medical vs. market realities, action items for Congress.



Thank you Google Images for use of Acinetobacter Outbreak map from Bioquell

Labels: Acinetobacter Baumannii, battle, contractors, Iraq, troops

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Thank you Dr. Emer for Grand Rounds 50! Remember September 9 10:30 PM HBO: ALIVE DAY MEMORIES: HOME FROM IRAQ

Thank you for including a link to my post Remember September 9 10:30 PM HBO: ALIVE DAY MEMORIES: HOME FROM IRAQ in Grand Rounds 50, a round up of medical writing in this week's blogosphere - on Parallel Universes...

You can preview the promo here: http://www.youtube.com/watch?v=gEZsuuOf3Ao

And a clip from the film as well: http://www.youtube.com/watch?v=1HFjnfMlRqM

Labels: Gandolfini, Grand Rounds, HBO, Iraq, veterans

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Labor Day 2007: New Face of Labor - Hired Guns

Our President has made a surprise visit to Iraq to meet with General Petraeus and assess the situation. Next Sunday, September 9, 2007, HBO will air Alive Day Memories: Home From Iraq and I have been writing about the types of injuries our servicemen and women are suffering in the Afghan and Iraq wars. We have 30,000 injured veterans of these two wars coping with disabilities today, and the HBO film by Executive Producer James Gandolfini gives us some insight into their struggle.

There is a big, new industry that has exploded along with the war on terror - that of private military/security contractors. This means new labor - and as a disability manager this is something that interests me. I can't help but wonder about their disability insurance, who pays for their injuries - are the contractors experiencing similar injuries? What happens when they do get injured? I am reading a fascinating book this weekend, Robert Young Pelton's Licensed to Kill: Hired Guns in the War on Terror - just a little light summer reading every American who wants to know what's going on with our world might want to read. Mr. Young has a link on his website for Insurance which takes one to Ingle International and Imagine Ltd. where one can purchase Special Risk Product insurance. The Specialty Insurance or KRE to those in the know, provides protection against "...kidnap and extortion..when traveling to dangerous places". Need it be said, "War is not an insurable risk," per Bruce Wood, of the American Insurance Industry.

Blackwater is the most well known of the private military contractors who provide"...security, peacekeeping, professional military and stability operations..." for profit. Contractors are former military, police officers,CIA, Special Forces agents and Navy SEALS. Triple Canopy is another - they seek Quiet Professionals and have openings in Emergency Medicine and IT for those of you looking for adventure.

Well, thank you Joseph Neff, Staff Writer for the (Raleigh Durham) News & Observer to Lynch Ryan over at Worker's Comp Insider for getting to the bottom of this issue. Questions like this really plague me and I lose sleep until I know the answers.

• 126,000 private contractors work for the US government in Iraq
• 1000 have died
• 13,000 have been injured
  
• Each is insured against injury or death on the job
• US taxpayers pay both the insurance premiums and the benefits thanks to two WWII era laws:
• 1941 Defense Base Act requires contractors to be insured
• 1942 War Hazards Act allows the insurers (not the insured) to apply to the US government to cover payments for contractors injured or killed
• No one is overseeing the amount the insurers are charging the government - so they are charging "exorbitant premiums" per Bunny Greenhouse, of the Army Corps of Engineers
• Greenhouse initiated the practice of competitive bids in 2005
• she fought down the minimum premium from $25,000 (even if the assignment was 2 weeks!) to $7,500
• because of her advocacy we no longer have "a monopoly price and a monopoly vendor"
  
• No agency regulates the premiums or tracks the costs
• Even the Government Accountability Office (GAO), the congressional watchdog agency, was unable to calculate the costs to taxpayers.
• The contractors insurance market is dominated by AIG

Dyncorp International has hired Mission Critical Psychological Services to help its employees who struggle with post-traumatic stress disorder (PTSD) upon completion of their assignments. Mental health issues are going untreated in private contractors returning from Iraq. Insurers are fighting the claims, and the civilian mental health community is ill prepared to deal with combat-related stress. AIG has paid about 50% of the PTSD claims filed.

This is one of those rabbit hole stories - the more you know, the more you realize you don't know. For more reading and to understand a new face of labor, visit AmericancontractorinIraq.
Happy Labor Day, whatever you do!

Thank you Jimmy theSuperstar for Iraq picture.

Labels: insurance, Iraq, military, private contractors, security

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US Military Casualities: Amputations at Record Numbers

Last summer a report from the Congressional Research Service based on Department of Defense information was sent to Congress detailing the US military casualty statistics in Operation Iraqi Freedom and Operation Enduring Freedom. Twenty percent of soldiers injured have multiple injuries - and may have traumatic brain injury (TBI) as well as traumatic amputations. All most half of the amputations are caused by IED's. These could be prevented if the transportation vehicles our troops are using had undersides designed to bear the impact of this well known threat. The MRAP is one such vehicle that the Marine Corp is now contracted to produce. It has a V-shaped underbelly desgned to protect against underground devices.

Advances in battlefield medicine have saved many combatants who might have died - but is the rehabilitation they receive up to par? The Center for the Intrepid, a $50M rehabilitation center in opened its doors in San Antonio, Texas in January, 2007 to treat the record number of amputees and troops with severe burns. Amputee rehabilitation programs are run at Brooke Medical Center in Texas, Walter Reed Medical Center and Bethesda Naval Medical Center. Housing has been built at Center of the Intrepid for families of the soldiers in rehab. The Center was funded by private donations from 600,000 US citizens, which means the world to the beneficiaries of the services provided. State-of-the-art technology is provided to military amputees including advanced prosthetics, computerized and video monitoring, biomechanical studies and advanced physical therapy methods.

One of these programs is the art program at the Center, a collaboration between the General Services Administration (GSA) and the Fallen Heroes Fund. The art work was chosen to complement the architecture, to remind visitors of the heroes and the sacrifices they have made for the US, and to support the physical rehabilitation programs and motivate participation in extreme sports. The Intrepid Fallen Heroes Fund and the Wounded Warrior Project has also just made available a publication " A Handbook for Injured Service Members and Their Families". The handbook provides information about what to expect, resources available and issues that will crop up. The handbook is available at www.fallenheroesfund.org.

New generation prosthetic devices are being designed by researchers at Arizona State University's Polytechnic campus and the Military Amputee Research Program at Walter Reed Army Medical Center. The Otto Bock C-Leg has a microprocessor knee and was introduced in 1997. It allows the wearer to go up or down hills and slopes and provides greater freedom of movement. Otto Bock also makes a myoelectric hand that is lightweight, compact and responsive.

If you want to get up close and personal with some of the amputees returning from Iraq, watch HBO's Alive Day Memories: Home From Irag from Executive Producer James Gandolfini. The documentary film premieres on September 9, 2007 at 10:30 PM and continues through September 16, 2007. Don't miss it - I have had a chance to see it and it is very moving. These American heroes have sacrificed their health and well being - they don't want us to forget them.

Labels: amputees, HBO, injuries, Iraq, prostheses, veterans, warrior

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REMEMBER SEPTEMBER 9 10:30 HBO: ALIVE DAY MEMORIES:HOME FROM IRAQ

Beginning Sunday September 9 through September 16, 2007 HBO will be airing the very special documentary by Executive Producer James Gandolfini Alive Day Memories: Home From Iraq. I had the opportunity to see the film this weekend and was struck by how unsentimental it is. Filmed on a black, blank stage, Mr. Gandolfini quietly interviews some truly tough men and women about what lead them to enlist in the service (Army or Marines), what they remember about the day they almost died, and the aftermath. There are no cheap attempts to manipulate our emotions. There are no judgments about the right or wrong of war or this war in particular. There are just ten human beings, aged 21-41, unique, full of life, energy, love, ideas, desires, hopes and dreams sharing their stories with Mr. Gandolfini.

Interspersed with the interviews are videos of the servicemen and women at home or at play or in Iraq before they were injured. There are videos of them in the hospitals and rehab centers or dancing after the injuries. Each has a story to tell.

Some of the facts Alive Day Memories: Home From Iraq educates us about:

• 90% of the wounded of this war survive their injuries
• the majority of the wounded cope with amputations, traumatic brain injury (TBI), post-traumatic stress disorder (PTSD)
• this war is seeing the highest percentage of amputees since the Civil War
• 50% of those wounded suffer from PTSD
• 33% of the injured suffer from TBI
  

Mr. Gandolfini calls them "True American heroes." And as HBO has observed, their fight has just begun. For the 30,000 wounded troops among us, and no doubt many more who will return to our shores, we need to rally round them, and help them with this fight. Watch this movie to gain a better understanding of their struggle.

See previous posts: War of Disabilities: HBO's Alive Day Memories: Home From Iraq Tells the Stories
Home From Iraq: HBO, James Gandolfini Focus on New Veterans

Labels: amputees, Gandolfini, HBO, Iraq, PTSD, TBI, veterans

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