The medical care of U.S. combat veterans can't rest solely with battlefield emergency rooms or government hospitals and their physicians.

"A lot of their care is going to fall on family physicians around the country," Dr. Francesca "Frankie" Cimino told an audience of doctors at a recent symposium, sponsored by the KU School of Medicine-Wichita.

Family physicians will have to ask their patients the right questions if they're going to identify and treat veterans suffering from conditions resulting from their military service.

The care of returning military personnel was one of many topics covered during the 33^rd annual Family Medicine Winter Symposium.

Cimino, a California native, is a lieutenant commander in the U.S. Navy, a family physician at the Bremerton Naval Hospital, and program director for the Puget Sound Family medicine Residency. In 2010, she served a seven-month deployment at a hospital in Kandahar, Afghanistan.

In the midst of daily attacks on the base, she saw about 6,000 patients during her deployment. "We got all the casualties from southern Afghanistan," she explained.

More than two million veterans have re-entered society since the start of the 13-year war in Afghanistan, out of a total veteran population of about 23 million. Kansas has around 220,000.

To adequately treat the large number of veterans, Cimino urged family physicians to ask patients if they or a loved one have ever been in the military. Cimino cited a case study of a 39-year-old veteran of the National Guard who was experiencing migraines and sleeplessness. With proper questioning, she discovered that the woman had suffered mild traumatic brain injury (TBI) when a bomb exploded outside her vehicle in Afghanistan. The woman suffered partial memory loss, a key symptom of TBI.

Although mild TBI is one of the "signature" injuries of the war, not all head trauma leads to it, and it can be difficult to distinguish from Post-Traumatic Stress Disorder (PTSD) or other diagnoses, Cimino said.

PTSD generally arises from witnessing a traumatic event. That's what happened to a 29-year-old man who began drinking heavily after his discharge. His job was to disarm wounded soldiers who'd been brought in for treatment. "He saw a lot of terrible injuries and a lot of limbs lost," explained Cimino.

The physical and psychological effects of war can linger for months, years, or a lifetime. In addition to medical conditions, veterans also face unemployment, addiction, homelessness, and suicide.

Cimino's experience in Afghanistan made clear to her that deployment "is not a normal thing," and a readjustment period to life in the U.S. should be expected. Deployment, she said, is a weird mix of sensory deprivation and overload, and the usual routines and comforts of home are exchanged for stress, excitement, and the camaraderie of a military unit.

She joked that government facilities would be facing a scene "out of a zombie apocalypse movie" is all those veterans sought care at the same time. Instead, civilian family physicians must be ready.

"If you're asking the questions, you might find a way to intervene," she explained. "You will undoubtedly change their lives just by asking the right questions."