TRMA 830
TRAUMA CASE STUDY: MILITARY
NARRATIVE
(Please note that while every question or statement may not be shown below or match word-
for- word the way the assessments are worded, there is enough information below to make an
informed decision using the assessment instruments. After carefully reviewing the assessments
and narratives several times, if you do not see a particular criteria or statement answered by
the narrative, you can safely assume that it is not part of the diagnostic picture for this client.)
John is a 27-year-old single man who served eight years in the Army (joining when he turned
18), and served three tours (each about 6-9 months) of duty in Iraq and Afghanistan, attaining
the rank of sergeant first class (E-7).
John came to the office about 25 minutes early and did a Beck Depression Inventory-2 (total
score = 20, mild-to-moderate depression), the Beck Anxiety Inventory (total score = 15, mild-to-
moderate anxiety), the Beck Hopelessness Scale (total score = 3, minimal hopelessness), and the
Beck Scale for Suicide Ideation (total score = 0, no suicidal ideation). After doing a Mini-Mental
Status Exam with him (total score = 30, normal cognitive functioning). He begins talking about
why he has come to see you today . . .
He starts off with saying he’s “not sure why I’m coming to see anyone . . . I should be able to
handle things myself. With as much training as I’ve been through, this is just another thing to
conquer. But I can’t seem to shake it . . . my parents encouraged me to come and talk, so here I
am.” He says he is currently living with his parents after his recent discharge (honorable) nine
months ago, is in reasonably good physical health. He used to like to hike (which he laughs
about considering how much he and his buddies hated the full-pack “hikes” when he was
serving) and ride his mountain bike (each are quite a bit harder now because of his back and leg
injuries), but he occasionally tries to jog and lift weights a couple of times a week. He mentions
he “pretty much doesn’t want to do any of those things these days.” He is actively looking for an
apartment or house to move into, but has had some trouble finding steady work. He
acknowledges that his parents “are great people,” but he feels “stifled” and “babied” by his mom,
due to his “nightmares and injuries” that still affect him from time-to-time. He is not currently in
a relationship, but is “dating someone” (he calls her his “girlfriend,” but he’s not sure if she
wants it to be serious at this time).
He says most of his patrols were pretty routine, he believes he participated in “easily more than
100 of them” (he had a “notch” on a stick for every one he went on, but it got lost when he was
, TRMA 830
injured on his last patrol), and was in at least 61 or 62 “firefights” with enemy combatants. He
really loved the “camaraderie of being with my team” and “knowing I could trust them with my
life.” He does say that there were about 18 or 19 situations that have really stuck with him of
where he and his team were ambushed and pinned down, where each teammate thought they
could be killed or seriously injured (including the one where he was injured). He says during the
total of 36 months that he was deployed “in-country,” he was under fire for over half of that,
many times with their camp (when he was in the Korengal Valley) being showered with mortar
or sniper fire until they could use counter-snipers to take out a target or get an assist from an
“Apache” helicopter unit to get the mortar crew.
On at least four of the ambushes, he knows he and his platoon were surrounded by the enemy,
and with all the “bullets flying around,” it was amazing that “everyone wasn’t hit.” He was very
proud of his team, platoon, and the company he was in, being led by “really competent captains
and “LTs” (lieutenants), along with great sergeants. Because he (and his company) were on so
many patrols, especially around Ramadi and some in Tikrit, there were “so many times that
someone was hit by incoming,” and when asked to give a number, he says “at least 40 to 50
times.” His company had one of the highest numbers for Purple Heart awards” (including two
for himself), but they also “had a pretty high KIA (killed in action) and WIA (wounded in
action) rate of about 30%.”
His final patrol was when he was riding with his team on the Eastern side of Baghdad, “in a bad
part of town,” so they were “on high alert.” Things had “gone pretty smooth for the most part”
and that they “had actually started to relax a little, looking forward to getting back to camp”
when on the last half of their patrol, they were struck by an EFP (explosively formed projectile)
and their Humvee was “blasted pretty bad.” Since he was the “tactical commander,” he was
monitoring everything from the front passenger seat. When they were hit by the EFP, the
Humvee did not roll completely over, but it still blew upwards, crashed hard back down, and
then landed on its side, with him “pinned against the door, which was wrecked and twisted, and
hot from the explosion.” The “shrapnel blasted through the bottom” and “tore up his feet and
legs up pretty bad,” and the Humvee landing on its side severely injured his back, giving him
“four cracked vertebra, but no spinal column damage, thank God.” One of his team manning the
M240 at the turret was killed, and the other two were both injured.
TRAUMA CASE STUDY: MILITARY
NARRATIVE
(Please note that while every question or statement may not be shown below or match word-
for- word the way the assessments are worded, there is enough information below to make an
informed decision using the assessment instruments. After carefully reviewing the assessments
and narratives several times, if you do not see a particular criteria or statement answered by
the narrative, you can safely assume that it is not part of the diagnostic picture for this client.)
John is a 27-year-old single man who served eight years in the Army (joining when he turned
18), and served three tours (each about 6-9 months) of duty in Iraq and Afghanistan, attaining
the rank of sergeant first class (E-7).
John came to the office about 25 minutes early and did a Beck Depression Inventory-2 (total
score = 20, mild-to-moderate depression), the Beck Anxiety Inventory (total score = 15, mild-to-
moderate anxiety), the Beck Hopelessness Scale (total score = 3, minimal hopelessness), and the
Beck Scale for Suicide Ideation (total score = 0, no suicidal ideation). After doing a Mini-Mental
Status Exam with him (total score = 30, normal cognitive functioning). He begins talking about
why he has come to see you today . . .
He starts off with saying he’s “not sure why I’m coming to see anyone . . . I should be able to
handle things myself. With as much training as I’ve been through, this is just another thing to
conquer. But I can’t seem to shake it . . . my parents encouraged me to come and talk, so here I
am.” He says he is currently living with his parents after his recent discharge (honorable) nine
months ago, is in reasonably good physical health. He used to like to hike (which he laughs
about considering how much he and his buddies hated the full-pack “hikes” when he was
serving) and ride his mountain bike (each are quite a bit harder now because of his back and leg
injuries), but he occasionally tries to jog and lift weights a couple of times a week. He mentions
he “pretty much doesn’t want to do any of those things these days.” He is actively looking for an
apartment or house to move into, but has had some trouble finding steady work. He
acknowledges that his parents “are great people,” but he feels “stifled” and “babied” by his mom,
due to his “nightmares and injuries” that still affect him from time-to-time. He is not currently in
a relationship, but is “dating someone” (he calls her his “girlfriend,” but he’s not sure if she
wants it to be serious at this time).
He says most of his patrols were pretty routine, he believes he participated in “easily more than
100 of them” (he had a “notch” on a stick for every one he went on, but it got lost when he was
, TRMA 830
injured on his last patrol), and was in at least 61 or 62 “firefights” with enemy combatants. He
really loved the “camaraderie of being with my team” and “knowing I could trust them with my
life.” He does say that there were about 18 or 19 situations that have really stuck with him of
where he and his team were ambushed and pinned down, where each teammate thought they
could be killed or seriously injured (including the one where he was injured). He says during the
total of 36 months that he was deployed “in-country,” he was under fire for over half of that,
many times with their camp (when he was in the Korengal Valley) being showered with mortar
or sniper fire until they could use counter-snipers to take out a target or get an assist from an
“Apache” helicopter unit to get the mortar crew.
On at least four of the ambushes, he knows he and his platoon were surrounded by the enemy,
and with all the “bullets flying around,” it was amazing that “everyone wasn’t hit.” He was very
proud of his team, platoon, and the company he was in, being led by “really competent captains
and “LTs” (lieutenants), along with great sergeants. Because he (and his company) were on so
many patrols, especially around Ramadi and some in Tikrit, there were “so many times that
someone was hit by incoming,” and when asked to give a number, he says “at least 40 to 50
times.” His company had one of the highest numbers for Purple Heart awards” (including two
for himself), but they also “had a pretty high KIA (killed in action) and WIA (wounded in
action) rate of about 30%.”
His final patrol was when he was riding with his team on the Eastern side of Baghdad, “in a bad
part of town,” so they were “on high alert.” Things had “gone pretty smooth for the most part”
and that they “had actually started to relax a little, looking forward to getting back to camp”
when on the last half of their patrol, they were struck by an EFP (explosively formed projectile)
and their Humvee was “blasted pretty bad.” Since he was the “tactical commander,” he was
monitoring everything from the front passenger seat. When they were hit by the EFP, the
Humvee did not roll completely over, but it still blew upwards, crashed hard back down, and
then landed on its side, with him “pinned against the door, which was wrecked and twisted, and
hot from the explosion.” The “shrapnel blasted through the bottom” and “tore up his feet and
legs up pretty bad,” and the Humvee landing on its side severely injured his back, giving him
“four cracked vertebra, but no spinal column damage, thank God.” One of his team manning the
M240 at the turret was killed, and the other two were both injured.
