The ‘invisible’ legacy of war: PTSD and medical case management

Broken bones eventually heal, but sometimes it’s the ‘invisible’ injuries which are the true legacy of a traumatic event.

Dealing with medical cases stemming from active war zones around the world means Tangiers International is acutely aware of the devastating impact of post-traumatic stress disorder (PTSD).

Characterised by symptoms including terrifying flashbacks, nightmares, emotional numbness or a loss of appetite, the disorder can severely impair patients’ abilities to hold down jobs or function in society following a mentally-scarring ordeal.

“The brain has essentially skipped a step,” explained Dr John Quinn, Tangiers’ medical adviser. “Instead of remembering it as the past, you’re remembering it extremely vividly – you’re constantly going back to that horrible, horrific event.”

Dr Quinn, a US-national and specialist in emergency medicine, began consulting for Tangiers in 2012 and finally joined the team full-time this year. Alongside overseeing the evacuation and treatment of patients for the company, he deals with the hardcore of PTSD cases which have proven resistant to standard medical protocol.

He said: “The patients I see are different because they are very complex. Their maximum medical improvement may be very elusive. Some of those patients will have gone and tried all of the therapies, gone to the absolute edge of what’s available.

“Sometimes the answer is, look, we have to go and try something else.”

By reviewing the course of treatment being offered to the patient, Dr Quinn ensures that every avenue of recovery is being explored.

“If it’s not working, you start thinking outside the box and start thinking about alternative therapies,” he added.

Although by no means exclusively a ‘war disorder’, PTSD has a strong association with conflict veterans due to its prevalence among soldiers returning from active service. For Tangiers, however, the focus is on civilian military contractors in countries such as Afghanistan or Iraq.

Dr Quinn explained that understanding the “mechanism of injury” (essentially, the event which caused the trauma) is fundamentally important for treating a patient.

“When it comes to mental health and traumatic events, firstly, it is the threat of violence. For example, if someone is in their car and three to four vehicles up a suicide bomber sets themselves off. Secondly, it’s actual violence: The bomber blows themselves up and they are in the vehicle right behind it, so there’s physical trauma.”

PTSD may manifest itself almost immediately following a traumatic event such as narrowly escaping death in a war zone. However, it sometimes takes weeks, months or even years for the patient to begin experiencing the full effect of the disorder.

The practical implications are that a patient may require specialist help long after any trace of their physical injuries has disappeared.

It also means compassion and time are integral components of ensuring an eventual recovery.

Dr Quinn added: “One thing that makes Tangiers a bit different from the other companies out there is that we view all of these people as patients. We need to get to the bottom of it as a patient.”