Sixteen times last year I delivered the worst kind of news a soldier's mother or wife receives. I had to inform them their loved one was injured in combat.

As difficult as this task may seem, it was complicated by the U.S. Army's antiquated system for keeping families of combat-wounded soldiers informed after a battlefield injury.

As a rear detachment commander assigned to the Army's 11th Armored Cavalry Regiment in California's Mojave Desert, my job was to handle the stateside affairs of a unit fighting around Baghdad. My foremost responsibility was to care for 196 families of deployed soldiers. While it was overall a joy and an honor to serve Army families, it sometimes meant I was the bearer of bad news.

We depend on an all-volunteer force and cannot afford to alienate our heroes and their families. Many years of satisfaction with military life can be destroyed the instant one is wounded and the Army fails to respond to the needs of his or her next of kin. Those who feel forgotten will likely choose not to reenlist, depriving our military of its most valuable resource. This is the reason why timely, sensitive, and professional notification is essential, and why the system must be revamped.

Currently, a casualty notice must ascend through the medical-reporting scheme overseas to a clearinghouse at the Pentagon. From there, the reports are distributed to regional authorities. If it is a fatality, they will dispatch a team of trained notification officials to the next of kin. These notifications generally meet the high standard our nation has set for such a solemn duty.

However, if the message involves a nonfatal injury, it is regularly delegated to the soldier's rear detachment, usually a small, stay-behind group at the unit's duty station. Rear detachments vary in size, composition, and experience, but they are frequently staffed by soldiers working on tasks above their rank. They don't have the formal training or the resources to promptly notify and assist family members of seriously injured soldiers. Most often, family members receive a phone call with a preliminary report of the incident. These terse, businesslike calls have become the modern equivalent of the telegrams once delivered by taxi.

A phone call might be appropriate for minor injuries. In serious cases, though, families deserve a knock on the door. But part of the reason that doesn't happen is messengers are often in a race against rumors and the media.

Technology has created a huge challenge to notification. E- mail, cell phones, and near-real-time television feeds mean the family may receive half-truths before the Army can deliver a full report. The current system to notify family members of an injury simply cannot compete with the rapid flow of information heading home.

Worse, those delivering notifications have little to provide relatives beyond the most basic facts. Follow-up reports on the patient's progress and whereabouts are crucial to reassure the family that their loved one is receiving the necessary care. Yet critical information is withheld within the medical community, mostly for fear of violating the 1996 Patient Privacy Act.

Notification is increasingly important because higher proportions of service members are surviving combat injuries. As of Feb. 4, 16,653 service members have been wounded and survived, accounting for 88 percent of all casualties. This is the highest such rate in our history.

Additionally more veterans are living with severe injuries. The rate of combat wounds requiring amputation has doubled in Iraq with respect to previous wars, jumping from 3 percent to 6 percent of injuries. Many others sustain traumatic head injuries that have lifelong effects. Media focus on the fatality count obscures this fact, though news reports have not underrepresented the impact of the improvised explosive device (IED).

Thankfully, IEDs are not as lethal as they could be because our progress in combat medicine and protective countermeasures like body armor have allowed more soldiers to survive. What hasn't improved are notification procedures.

A better system begins with a congressional review of privacy regulations. Then we must consolidate the separate databases used to manage medical, personnel, and transportation information, and make them accessible — especially to notifying officials. We must train and provide resources to notification teams for the seriously injured, not just for fatalities. Finally, we must create procedures for rear detachment operations — there are almost none now.

These are not easy tasks. But our lawmakers and military leaders must address the problem now so service families no longer endure the consequences of insensitivity.
___________________
Alec Barker (alecbarker@jhu.edu) is a graduate student at the Bologna, Italy, campus of the School of Advanced International Studies at Johns Hopkins University.

© 2006 Alec Barker. Republished with permission.

© 2006 The Johns Hopkins University. Baltimore, Maryland. All rights reserved.
Last updated 04Mar06 by dgips@jhu.edu