Wednesday, April 13, 2011
The Department of Veterans Affairs reports car crashes are a leading cause of death among combat veterans during their first years home. We'll find out the scope of the problem, why it's happening and what is being done to address it.
Homecoming ceremonies have been taking place on Camp Pendleton this week, welcoming Marines who've served a hard deployment in Afghanistan. Readjusting to civilian life is a challenge for most combat veterans, and the military is working to better address the emotional and physical needs of returning marines. But one challenge that is starting to gain more attention, is readjusting to civilian driving.
KPBS Senior Metro Reporter Alison St. John
CAVANAUGH: I'm Maureen Cavanaugh, and you're listening to These Days on KPBS. Homecoming ceremonies have been taking place on Camp Pendleton this week, welcoming marines who've served a hard deployment in Afghanistan. Readjusting to civil yap- is a challenge for most combat veterans, and all branches of the armed serves are working to better address the emotional and physical needs of returning military personnel. One challenge that's getting attention is how combat veterans can safely readjust to civilian driving. Here to tell us more is my guest, KPBS senior metro reporter, Alyson St. John. Good morning, Alyson.
ST. JOHN: Good morning, Maureen.
MAUREEN CAVANAUGH: So the Department of Defense tells us that driving accidents are a real risk for combat veterans of what's the scope of the problem.
ST. JOHN: Well, the retch has shown in the past that 31 percent of the people who died when they returned from deployment died in traffic accidents from the gulf war. That was the gulf war. And their research is still ongoing now, to look at whether that still holds true for people coming back from Iraq and Afghanistan. But bearing in mind that things like traumatic brain injury, which can affect driving, which is one of the signature injuries from the Iraq and Afghanistan wars, it seems likely that that figure could be much higher. And research has shown already that definitely motorcycle accidents are much more likely to result in a fatality. And the civilian population, it's about 15 percent in motorcycles relate in fatalities, where's, like, 35 to 45 percent of those recently returned from combat military do. So there is definitely a lot of evidence that this is one of the things which is a risk for a service member who's survived goodness knows what in a combat zone and come back and get injured or even die in a traffic accident. And one of the occupational therapists at the naval hospital in Balboa, Tommy Núñez, talked about a wit of the background to their work, and here it is.
NEW SPEAKER: There is a lot of research being done right now, trying to gauge exactly the percentage of incidents of driving recklessly returning from deployment, and so far the stats do show an increase in driving accidents.
ST. JOHN: It seems like the research is definitely -- I haven't found any conclusively research, I've looked and seen that there's been some conflicting research, but it's likely that research will start to reach some conclusions pretty quickly to show that this is an area that does need more attention.
MAUREEN CAVANAUGH: Well, based on the numbers that we already have the gulf war, and the ongoing research they're doing now, it may seem that there is a trend in combat vets having a difficulty readjusting to civilian driving, civilian motorcycle riding. So what -- what is understood about what linkage there may be about returning from deployment and having traffic accidents?
ST. JOHN: Well, the -- perhaps the easiest to talk below is the traumatic brain injuries, which we've heard quite a lot about, and a high percentage of the returning vets from combat are suffering from some level of TBI. Most of it is mild TBI, and a certain percentage of those with mild TBI don't recover after the 503 months, those symptoms hang on. And those symptoms are really things that could affect your driving. It's things like visual depth perception, perhaps auditory effects, not so good on hearing, attention deficit, the fact that driving, we don't realize how much you have to pay attention.
MAUREEN CAVANAUGH: Right.
ST. JOHN: But sustained periods of attention is difficult for somebody suffering from TBI. Their scanning abilities are affected, and their reaction times are slowed. They may be -- become disoriented sort of unexpectedly. All of these things are obviously things that are going to affect your performance on the road. And then most people who have TBI -- well, there is an interconnection between TBI and post traumatic stress disorder.
CAVANAUGH: Let me stop you on traumatic brain injury, and you're speaking mostly about the milder forms of traumatic brain injury now, and people may not realize that that indeed may affect their driving. I know you've done a lot of reporting on this in the past, Alyson, so what kinds of injuries could result in traumatic brain injury for a returning veteran.
ST. JOHN: Oh, you mean, how do they get the condition?
MAUREEN CAVANAUGH: Yeah, yeah.
ST. JOHN: It's mostly from these i.e. Ds of these improvised explosive device. Which -- if you get caught in one of those, there are shock waves that affect the brain. And I think there's a lot of research going on in San Diego right now, as to how those shock waves are affecting the brain, and where the brain recovers, and what kinds of things can help the brain recover. So it's something which is very prevalent among the service members returning from active duty. And people here in San Diego, I know accident are getting millions of dollars to research more into that.
MAUREEN CAVANAUGH: Now, you spoke with a doctor here in San Diego who basically says a lot of people -- a lot of returning veterans, you know, just will jump back in the car, jump back on the motorcycle, don't even realize that they might have some sort of impairment.
ST. JOHN: Well, yes, that's true. And of course we don't -- we take driving for granted, and especially in California, it's very hard to live your life without being able to drive. So even if you may feel a little insecure, you probably aren't going to admit it. So for patients who are being treated, if you ask them, are you okay to drive, they're most likely, according to the doctor, to answer this way. Here's what his experience is.
NEW SPEAKER: Unfortunately, a lot of the Marines that come back from conflicts get on their motorcycles and get in their cars and sometimes have accidents, and end up with other kinds of injuries, including brain injuries, and we're still seeing quite a few of those people.
ST. JOHN: So he is saying -- this is doctor Michael Lobatz from Scripps Encinitas, and they have a driving simulator which they're using to test people who have T, about I, and he says that initially the military was very interested in their facilities. They have a brain injury treatment center, and they had a lot of things the military were not familiar with. And they got a lot of visits from people from the military, interested to find out more about what they were doing. Now he says they're getting fewer visits from patients from the military who have suffered TBI, but they're still seeing people who come back and have suffered traffic accidents.
MAUREEN CAVANAUGH: And that's why they have the injury. Yes, yes.
ST. JOHN: And sustain another brain injury, and it's sort of compounded. So that's the second reason why there may be more people coming to the hospitals from the military looking for assessments for their driving.
MAUREEN CAVANAUGH: And you were making the linkage that many people do, people who suffer from mild TBI symptoms from their combat services are also perhaps more likely to develop post traumatic stress disorder. And that also can impact driving. How does that impact driving.
ST. JOHN: Well, actually it's not the TBI causes PTSD, it's just the two things are present, the sort of overlapping conditions and symptoms. So it's very common for someone who has been diagnosed with TBI might have some symptoms of PTSD too, and that also can affect driving abilities, there's this feeling of invincibility the doctor was talking about, how sometimes service members come back with this very high adrenalin level, and there's a sort of tendency to want to seek to get back to that level again. Or another symptom is depression, which is very understandable, and to help deal with the pain, quite a bit of drug and alcohol use. That can also affect driving. And then the third thing really, which is that the training for how to drive defensively in a combat zone is very different from how you would drive in a civilian area. And I've spoken with veterans who found it difficult to drive on the edge of the road when they got back because that's where the i.e. Ds are. So it's safer to drive in the middle of the road on the center divide line, which that is asking for trouble. Also driving fast to get to where you're going, so when you get there, you can feel safe, because they don't feel safe on the road. And evasive tactics , you know, changing lanes, or loud noises that will stimulate some kind of a stress reaction that will cause some kind of reaction on the road. There are so many things that could really affect how safe somebody is on the radioed when they come back. And they may not even be aware of that, really until something happens.
MAUREEN CAVANAUGH: I'm speaking with KPBS senior metro reporter, Alyson Saint John about a feature that she's justice done about how combat veterans can safely readjust to civilian driving. And I guess the big question here, Alyson is how is the military addressing this problem.
ST. JOHN: Well, they have, in 2009, adopted an initiative, a safe driving initiative, and there are safer driving centers around the country, there's the naval medical center here in San Diego has a driver rehabilitation service, and the VA though, now, you have to bear in mind that people who are still in active duty get their care from the Department of Defense health services, and the people who are disarmed go to the VA. And the VA here in San Diego also has some facilities for driver rehabilitation, but it doesn't appear -- they certainly don't have a simulator, which the naval hospital does. Sharp and Scripps are the two private hospitals that have driving simulators of one of the things that strikes me, we're spending millions of dollars, we recently heard about a 30 million dollar virtual reality training facility opening up on Camp Pendleton to help the service members go and fight effectively in the war zone, and that a driving simulator is expensive, it costs about a helped thousand dollars according to doctor Michael Lobatz, but you would have thought that it might be worth investing in some more training here in this country to help marines when they get back from combat to readjust and to perform safely on our civilian roads.
MAUREEN CAVANAUGH: You spend some time with doctor Lobatz, and with this driving simulate. Tell us a little bit about that. And you spoke with someone who used it, and with the doctor about how it's used.
ST. JOHN: Yes, well, basically, you know, you sit in a little room and face a screen, and you got your steering wheel in your hand, and the gas, and the accelerator, so it is a little like a car, although the patient I saw using it said it was somewhat sluggish, and you're basically just trying to match your reactions to the video on the screen. So it's not quite the same as driving in the sense that you don't determine the outcome, but you're trying to match the video on the screen. And then a computer can measure very accurately every single push on the accelerator, every turn of the wheel, and come out with a very objective report as to whether you are keeping up, and whether your attention over a period of time is good. And meeting the demands of driving. The particular program that I saw was of a sort of fairly rural road, however, I do understand there are some for freeway driving too, which is important because of course it's much more intense to drive on a freeway, especially in Southern California.
MAUREEN CAVANAUGH: Now, doctor Lobatz, I believe, told you that when people are sitting in front of this simulator, most of them say, basically, I'm okay. I don't need this kind of thing.
ST. JOHN: Right, yeah. That is the problem. And in fact, he said, look, I'm a doctor, I'm not here to take somebody's driving license away. All I can do is do these assessments, and then the department of motor vehicles would make a decision about that. And then the occupational therapist who was using the simulator made the point that they work very carefully with each patient for quite a while before putting them in the simulator so that they have the best possible chance of performing well. It's not like, you know, a patient might be put on the simulator and then told, boom, you're gonna lose your driving license. Because that is really a big disadvantage for anybody trying to reassimilate into our society getting back from deployment. If you can't drive, that's a major handicap. So they're not in a position to remove someone May driving license. But however, the DMV could be if there was enough evidence.
MAUREEN CAVANAUGH: And doctor Lobatz basically said that it's not easy for a person to admit that their driving skills might be compromised.
NEW SPEAKER: When I asked the question, well, are you safe to drive again, are the patient is mostly all the time going to say yes. So the only way to really know whether somebody's really safe to drive or not after an injury is actually put them in the car, or a simulator, or both, with an occupational therapist that knows what they're doing, and get them tested.
ST. JOHN: Which is really why I feel lake these simulators are such a key element of the whole treatment program. They've got one in Palo Alto at the VA there, but they don't have one here in San Diego. Which I have to admit, I find kind of surprising because they are the recipient of millions of dollars for looking into treatment of stress related injuries among service members.
MAUREEN CAVANAUGH: And not to seem terribly hard hearted about this, of course, we're very, very concerned about how our returning veterans are doing on the road. Wee also concerned about how everybody's doing on the road. And if you have somebody engaging in risky driving behaviors, that can affect us all.
ST. JOHN: And San Diego has a very high proportion of people who are returning from combat coming into this community and living here. Yeah. That's right.
MAUREEN CAVANAUGH: Well, I want to thank you so much. And I know that you're gonna keep tabs on this for us. Thank you, Alyson.
ST. JOHN: Sure.
MAUREEN CAVANAUGH: I've been speaking with KPBS senior metro reporter, Alyson St. John. If you would like to comment, please go online, KPBS.org/These Days. Coming up, we'll explore the charms and the allegations of game fixing at USD. That's as These Days continues here on KPBS.