Reserve medical Airmen learn about PTSD Published June 7, 2013 By Airman 1st Class Madelyn McCullough 446th Airlift Wing Public Affairs MCCHORD FIELD, Wash. -- Anywhere from 11 percent to 20 percent of servicemembers who deploy to Iraq or Afghanistan, return with post-traumatic stress disorder, according to the National Center for PTSD. That includes Reservists here, who often transition from a deployed environment to their civilian lives in only a few days time. To better understand how to help Airmen with PTSD, Reservists from the three 446th Airlift Wing medical squadrons participated in resiliency training June 2. The Stress of Combat Medicine, presented at the 446th Aeromedical Evacuation Squadron auditorium, covered a variety of mental challenges medical professionals may experience while deployed. One of those conditions was PTSD. "There is a misnomer out there that somehow medical people are given some sort of specialized training that protects them or insulates them from combat trauma and there really isn't," said retired Capt. Ed Hrivnak, a former flight nurse with the 446th AES who provided the training. According to Lt. Col. (Dr.) Keith Brown, 446th Aeromedical Staging Squadron officer in charge of mental health here, PTSD may stem from experiencing combat directly to driving in a convoy every day. "In my 20 years being in the military, most of that being in the 446th Airlift Wing, my deployment in 2003 by far was the hardest and most significant thing in my life," said Hrivnak, a published writer. "But it was also the most rewarding. It's an experience I would not want to give back. I consider it the high-water mark of my military career taking care of those soldiers and bringing them home. Hrivnak continues to take care of people by sharing his experience and what's he's learned about PTSD in his books and through his presentations. Hrivnak has traveled the country teaching about PTSD and the stress of combat medicine and how to recognize compassion fatigue. "We all live with some kind of denial of our own mortality," said Brown, a Woodinville, Wash., resident and the senior medical director for the Centene Corporation. "We realize at an intellectual level that something terrible could happen to us at any time, but we live with the denial so that we can get through our daily lives. When you experience trauma, that denial is ripped away. All of a sudden the reality of danger and death becomes too real." Although this can happen anywhere, many military members feel like they don't have a right to be traumatized because they weren't actually in combat. "People have come back who may not have experienced necessarily a specific trauma; but just being day in and day out riding in a convoy and knowing IED's were nearby, even though they never encountered one, they come back and have a great deal of difficulty adjusting to life back home," said Brown. Other examples include those who work in emergency medical operations who might be traumatized by what they see during their missions and those who handle human remains in mortuary operations, he said. After experiencing trauma or living in a dangerous environment for so long, Reservists sometimes find it difficult to readjust to their civilian lives. "How do you go from treating casualties to flipping a mental switch and taking care of your children?" said Hrivnak. "There is a stress response system in the brain that's activated to allow you to function in an intense environment," said Maj. Brian Cunningham, 446th ASTS and Utah Department of Veteran's Affairs psychiatric mental health nurse practitioner. "Neuropathways are laid down that allow you to function with very little sleep in a stressful environment. You're ready to respond to danger and the brain itself has changed." For some, that stress response system doesn't fully shut down when they go back to their normal living situation or work environment, he said. The brain is not wired for spending time with family or driving on a city road. It is still wired for the war environment and needs time to recover. "Reservists are thrown immediately back into an environment where there are not a lot of people who can relate to their experiences," said Cunningham, a Centerville, Utah resident. Hrivnak found that sharing his experience in his first book helped one nurse reach out to him. "I personally know a nurse who was on my crew who became homeless and unemployed because of what she experienced overseas. And it was only because she called me one day. I hadn't talked to her in years; she read the book "Operation Homecoming" and realized she was not alone. I talked to her for an hour and I convinced her to go to the VA (Veterans Administration) and she got help. And she now has a job at the VA, said Hrivnak" Although a servicemember may struggle with opening up to his or her family, some symptoms of PTSD may be present when readjusting to normal life. "A patient I had a few years ago was a Vietnam vet," Brown said. "He talked about the things he'd done in Vietnam that he wasn't proud of, where they were pretty cruel to the civilian population. He did some horrible things and felt very guilty about it later and he said to me, 'How would I ever date a woman? Because if she didn't know what I did in Vietnam, she wouldn't really know me. And if she knew what I did in Vietnam, she wouldn't want to know me." Major factors of PTSD include re-experiencing phenomenon in the form of flashbacks and intrusive memories, experiencing anxiety or being easily startled, and avoidance of situations that might remind them of the trauma, said Brown. But, even though trauma can rewire the brain, recovery does happen and is expected. Many individuals will experience post traumatic growth. "We may see an Airman who is very traumatized and is unable to function in the military at this time," said Brown, "but that is no reason to end your career. Full recovery is expected." There are plenty of treatments for PTSD such as psychotherapies called cognitive processing therapy and prolonged exposure therapy, and medications, Cunningham said. These can treat some of the symptoms of PTSD, as well as other issues that can come with PTSD like depression, anxiety, or substance abuse. Despite the presumed stigma of reporting the disorder, medical professionals encourage servicemembers to ask for help. They are not alone and support is available to them, including Reservists who may not have the same medical care access as their active duty counterparts. "Seeking help is okay," said Brown. "Asking for help is not a sign of weakness. As far as I know, having compassion is a sign of strength. Being troubled by what you see and growing through it is much easier when you have the support and help of professionals, friends, and wingmen. The hardest part is admitting that you are having trouble with it." For PTSD treatment options and combat veteran peer support, call 877-927-8387 to receive a referral for an appointment with a veteran's clinic in the local area or visit http://www.ptsd.va.gov/. Other sources of support include include first sergeants, chaplains, and Military OneSource.