The same day the British Medical Journal reported an increased risk of psychological problems for military personnel after prolonged periods of service in Iraq and Afghanistan, six physicians spoke about post-deployment medical care of reservists at the 2007 CIOR Summer Congress in Riga, Latvia.

NATO countries’ approaches to medical care may vary in length and implementation, but all recognize the need for evaluation and support of returning reservists.

“We have two types of trauma victims who return to the U.S.,” said Maj - Gen. (Dr.) Robert Kasulke, assistant surgeon general for the U.S. Army. “Those who return with obvious wounds and those who don’t show any signs of physical injury.”

Speaking at the CIOR’s post-deployment care symposium, Dr. Kasulke said once injured patients are stabilized, they are initially airlifted to Landstuhl Medical Facility in Germany, before transfer to the U.S., Those who are stable enough are flown directly to the U.S. 

“Once they reach a regional medical center in United States, the patients receive continuation of care until they are realistically ready for rehabilitation,” he said. “All of our regional medical centers have ultra-modern equipment.”

Rehabilitation in the United States includes sophisticated equipment, high tech prosthetics, some with computerized input.

“Sometimes the trauma victims return to duty, sometimes they stay in the service, sometimes they medically retire and sometimes they retrain,” said Kasulke.

On the other hand, Dr. Kasulke said it’s more difficult to detect mental trauma.

“Sometimes things show up on the medical records of returning service members and the process starts then,” he said. “But that’s the minority.”

Many people apparently don’t want to admit this, because they don’t want to stay on the base any longer after returning home.

“We have a mandatory health assessment about 30 days after they get home,” he explained. “It’s mostly simple yes or no answers.”

Some questions deal with mental issues and anxiety concerns. If a service member answers “yes” to a question, it is reviewed by a health care professional.

“We’ve learned that many problems don’t become evident at the 30-day mark,” said Dr. Kasulke.

The doctor said the United States was still improving its care of reservists who live in remote areas. 

“Sometimes they get lost in the system and didn’t get adequate follow-up because they are in rural areas,” he said. “So we recently set up community-based medical care organizations at eight locations around the states. The people at these facilities maintain frequent communication with returning veterans in those geographical areas. They make sure appointments are kept for trauma victims and ensure care is given in a realistic fashion.”

The German system of medical care, on the other hand, is broken into three different phases: preparation for deployment, during the deployment and following the deployment. Phase 1 focuses on anticipating the expected burden, boosting of mental balance and minimizing stress. Phase 2 focuses on identifying acute mental stress reactions and critical incident stress management. In Phase 3, the Germans offer a burden assessment, preventive cures, wrap-up workshops, and, if necessary, a special diagnosis centre. These phases each have three levels of care.

“Level 1 is carried out by comrades, seniors, superiors,” said Col. (Dr.) Gunter Ruetter, German Armed Forces Joint Medical Service. “Level 2 is carried out by pastors, priests and social workers (for deployed soldier and family at home), and level 3 is higher depth of care offered by psychiatrists, medical and psychological psychotherapists.”

 “We don’t have that much experience in Germany (with PTSD) because we haven’t taken part in very intense warfare,” said Dr. Ruetter. “Less than one percent of our soldiers suffer from PTSD.”

The Belgium approach focuses on the use of medical files. Lt.Col. (Dr.) Filip Stragier said the medical file is first looked at prior to deployment, and occupational health specialist determines if the service member is fit to deploy. The file goes along with the person during operations until the service member returns.

“If there is illness or trauma after deployment, the reservist can apply for free medical treatments upon return home, but it has to be done within the first three months,” said Dr. Stragier. “For the most part, there are no problems.”

The country of France uses a structured medical policy which ensures mobilized reservists keep their civilian health coverage.

“Our reservists have the same rights and duties as the regular forces and follow the same procedures,” said Major General Etienne Tissot from France. “Our reservists are sent on an individual basis. Last year we deployed a thousand reservists.  Typically, our rotations are smaller, consisting of 120 days. They are shorter periods compared to the active duty.”

The French general said the country has 12,000 active military reservists in operations outside of France with a tri-service approach.

The Danes use education strategies when their reservists deploy. 

“The first part of the pre-deployment process is to distribute pamphlets explaining the facts about the mission area, how to keep in contact, and what is to be expected upon deployment,” said Major General Jens Frandsen. “During the deployment they are given a contact for psychological arrangements, for which a psychologist is assigned to the unit in a non-deployment status to help support any requests for help.  As a minimum, a response can be turned out within 24 hours.”

The Danish general said after completion of the deployment, service members complete a mandatory medical interview.

“Then, during the next three months, they are in contact with the unit to talk about any issues from the deployment, and then at six months a follow-up questionnaire is distributed.”

He said only six to seven percent of Danish Reserve members are contacted for support after review of the questionnaire, and the therapy involves all family members.

“Typically, the ‘buddy system’ is used where the soldiers look out for each other and stay in contact with the unit.  We also make sure our soldiers get a formal military psychological review and have a climate conducive to talk about issues which all family members can participate. There is no time limit for help.”

Brig. Gen. Barthold Hals from Norway said the Norwegian pre-deployment and post-deployments were very similar to the Demark’s standards. 

“The civilian health care system takes care of all our reservists,” said the Norwegian general. “Our reservists are also always in close contact with the home unit, which has been best to reduce post traumatic issues or any mental health issues,” said General Barthold Hals from Norway.