Army health care operations in Iraq.

Four years of warfare in the urban environment of Iraq have produced fundamental changes in the Army's health-care system. First, improved communications and air evacuation have streamlined the transport of the wounded soldierfrom the battlefield to stateside medical centers. Second, individual ballistic armor has decreased the number of U.S. troops killed while the number of wounded soldiers has increased. Third, battling an unseen enemy has produced a marked increase in acute stress disorder, post-traumatic stress disorder and traumatic brain injury. Deployment of soldiers with chronic mental health disorders such as anxiety, attention deficit disorder, and depression is problematic. The stress of long combat tours has doubled the incidence of abuse and neglect in children of deployed service members. Comparedto active-componentsoldiers, the prevalence ofmental health disorders is twice as great in soldiers of the Army Reserve and Army National Guard. Finally, the difficulty in determining friend vs. foe in Iraq results in the incarceration of thousands of Iraqis creating both medical and ethical challenges for Army physicians.