A Consideration of Voting Accessibility for

Injured OIF/OEF Service Members: Needs

Assessment

July 2012

Contract E4064914

2010 Voting Technology and Accessibility Research – Military Heroes Initiative 

CFDA #90.403

PREPARED FOR:

Election Assistance Commission 

1201 New York Avenue, N.W. 

Suite 300

Washington, D.C. 20005

PREPARED BY:

Human Systems Integration Division 

Electronic Systems Laboratory 

Georgia Tech Research Institute 

Georgia Institute of Technology 

Atlanta, Georgia 30332
Annotated Literature Review Results

Other Injuries & Disabilities

Aiken, L. J., Bibeau, P., Cilento, B., & Lopez, E. (2008). Stateside care of marines and Sailors injured in Iraq 

at the National Naval Medical Center in Bethesda, Maryland. Critical Care Nursing Clinics of North 

America, 20, 31-40.

This paper describes the types of injuries that are most frequently seen in marines and sailors 

serving in Iraq and Afghanistan. Head injuries, TBI, and blast injuries are the most prevalent. 

Recently wounded warriors who are being treated in intensive care units (ICU)for TBI and other 

injuries often experience confusion and disorientation. This paper describes several case studies 

of ICU care at the National Naval Medical Center.

Bellamy, R. F. (2000). Combat trauma overview. In R. Zajtchuk & C. M. Grand (Eds.), Anesthesia and 

perioperative care of the combat casualty, (1-42). Washington, D. C.: Department of the Army.

It is critical for military anesthesiologists understand the unique challenges that they will face in 

the field – challenges that are quite different from those present in the civilian domain. This 

paper provides a broad but thorough historical overview of the types of injuries and methods of 

treatment that have occurred in recent U.S. military conflicts. Special attention is given to the 

environments in which injuries occur, the effects of the environment on patient prognosis, and 

the typical outcomes of various injuries.

Champion, H. R., Bellamy, R. F., Roberts, P., & Leppaniemi, A. (2003). A profile of combat injury. The 

Journal of Trauma, 54, S13-S19.

The causes and contexts of injuries in civilian and military sectors differ greatly; combat-related 

injuries bear unique considerations with regard to treatment. These include the following: the 

high energy of the wounding objects, multiple causes of injury, high frequency of penetrating 

wounds, the persistence of threat during immediate treatment in tactical settings, the resourceconstrained environment, and delayed access to recommended treatments. Recognition of 

these factors may improve research on medical care in combat settings, and may enable better 

civilian-military collaboration in research.

Clark, M. E., Bair, M. J., Buckenmaier, C. C., Gironda, R. J., & Walker, R. L. (2007). Pain and combat 

injuries in soldiers returning from Operations Enduring Freedom and Iraqi Freedom: Implications for 

research and practice. Journal of Rehabilitation Research & Development, 44(2), 179-194.

The rate of blast-related injuries has been increasing in recent military conflicts. Military 

personnel suffering from blast injuries typically require significant pain management. Although 

clinical practices and the management of pain have been progressing, there has been a lack of 

associated research. Little is known about the long term pain management needs individuals 

who suffer from blast-related injuries. This paper reviews the current methods for pain 

management, acute stabilization, transport, surgical treatment, and rehabilitation.
Clark, M. E., Walker, R. L., Gironda, R. J., & Scholten, J. D. (2009). Comparison of pain and emotional 

symptoms in soldiers with poly-trauma : Unique aspects of blast exposure. Pain Medicine, 10(3), 447-

455.

A retrospective review of medical records was conducted to determine whether soldiers with 

blast-related polytrauma presented physical and emotional signs and pain-treatment outcomes

that were distinct from those of soldiers who were injured by other means. Soldiers who were 

injured by blasts showed a wider variety of physical injuries, higher levels of opioid analgesic 

use, less reduction in pain intensity after treatment, and higher rates of psychiatric disorders 

than those injured by other means. Blast injury may be associated with a large number of 

comorbid symptoms that pose greater challenges than other injuries for successful treatment.

DoD Military injury metrics working group white paper (2002).

The Military Injury Metrics Working Group was assigned the task of identifying appropriate and 

standardized injury metrics for the Department of Defense. This paper documents those 

metrics, the best sources of information regarding the metrics, and identifies limitations and 

consequent recommendations for improving the metrics. The group recommends four new 

metrics and provides suggestions for the collection of data regarding injuries. The metrics can be 

used to track the progress of injury prevention and treatment programs.

Galarneau, M. R., Hancock, W. C., Konoske, P., Melcer, T., Vickers, R. R., Walker, J., & Zouris, J. M. (2006). 

The Navy-Marine Corps Combat Trauma Registry. Military Medicine, 171, 691-697.

This paper describes the development of the Combat Trauma Registry (CTR) and presents 

studies and analyses of combat injury patterns and casualty management in the medical 

evacuation chain in Iraq. The CTR is a database for records of combat injuries that describe the 

mechanisms of injury, use of personal protective equipment, casualty demographics, levels of 

care that were provided, and other details associated with injuries.

Holcomb, J. B., Stansbury, L. G., Champion, H. R., Wade, C., & Bellamy, R. F. (2006). Understanding 

combat casualty care statistics. Journal of Trauma, 60, 397-401.

Treatment strategies can rapidly be adjusted in response to hospital records, but the records 

must be maintained well. The raw data must also be interpreted to form actionable conclusions. 

This requires clear and consistent terminology. The authors developed a terminology that they 

hoped would produce the best insight into the effectiveness of clinical care at different stages of 

treatment. The terminology can be applied the analysis of injury data from the Joint Theater 

Trauma Registry (JTTR) to determine whether treatment methods are improving.
Lew, H. J., Poole, J. H., Vanderploeg, R. D., Goodrich, G. L., Dekelboum, S., Guillory, S. B., . . . Cifu, D. X. 

(2007). Program development and defining characteristics of returning military in a VA Polytrauma 

Network Site. Journal of Rehabilitation Research & Development, 44(7), 1027-1034.

The Polytrauma Network Site (PNS) clinic is a critical component of the Department of Veterans 

Affairs (VA) Polytrauma System of Care. The PNS serves military personnel who are returning to 

the U.S. from combat. Injured military personnel in the current conflicts show a high prevalence 

of post-concussion symptoms, PTDS, cognitive deficits, back pain, headaches, visual and 

auditory disabilities, and problems with the vestibularsystem. An anonymous patient feedback 

survey has been used to critique and improve the clinical process.

Knapik, J. J., Canham-Chervak, M., Hauret, K., Laurin, M. L., Hoedebecke, E., Craig, S., & Montain, S. J. 

(2002). Seasonal variations in injury rates during US Army Basic Combat Training. Annals of Occupational 

Hygiene, 46(1), 15-23.

A review of previous literature suggested that injuries sustained during physical activity may be 

higher in the summer months than in the fall and winter months, perhaps due to the fact that 

people are more physically active in the summer. To examine this possibility, this study 

reviewed seasonal differences in injury rates during US Army Basic Combat Training, where 

physical activity was similar throughout the year. Injury data were obtained from a retrospective 

review of the medical records. For men, the risk of incurring an injury in the summer was 

significantly greater than the risk during the fall months. There was a high correlation between 

maximum daily temperatures and injury rates. Thus, environmental factors may contribute to 

the higher rate of injuries during the summer.

Masini, B. D., Waterman, S. M., Wenke, J. C., Owens, B. D., Hsu, J. R., & Ficke, J. R. (2009). Resource 

utilization and disability outcome assessment of combat casualties from Operation Iraqi Freedom and 

Operation Enduring Freedom. Journal of Orthopedic Trauma, 23(4), 261-266.

This study focused on the costs associated with disabilities resulting from the wars in Iraq and 

Afghanistan, and also provided a few ideas for obtaining data on injury and disability rates. 

These sources include the Joint Theater Trauma Registry (JTTS), The Department of Defense 

Medical Metrics (M2) database, and the US Army Physical Disability Administration database.

Pollack, P., & Rogers, C. (2007). A brief background of combat injuries. Retrieved from

http://www.aaos.org/news/bulletin/marapr07/research2.asp.

Wounds that are caused by blasts and high velocity projectiles are much more common in 

military than civilian settings. Thus, the ability to generalize lessons learned from the treatment 

of civilian injuries to the treatment of military injuries is somewhat limited. This report describes 

some of the current trends in military injury statistics and associated challenges.
World Health Organization. (2002). Towards a common language for functioning, disability, and health: 

ICF. Geneva: Author.

The International Classification of Functioning, Disability, and Health (ICF) provides a standard 

language for the description and classification of health-related states. It is a classification of 

health-related factors that can be used to describe changes in body function and structure, as 

well as the physical capacities associated with each health condition. These factors are classified 

from several perspectives, including body, individual, and societal, by means of two lists: a list of 

body functions and structure, and a list of activities. The term “disability” is an umbrella term 

that includes functional impairments and activity restrictions. The classification scheme also lists 

environmental factors that may interact with these factors.

World Health Organization. (2008). Training manual on disability statistics. Bangkok: United Nations.

This manual asserts that accurate disability statistics are very important for the ability to 

determine the needs of specific individuals, because although two individuals may share the 

same impairment, they may face different types of difficulties in their daily lives. Therefore, 

information about an individual’s functional status is crucial for determining their social needs 

and assistive technology needs. This manual is based on initiatives to improve disability statistics 

and measurement by promoting a common definition and methodology that is based on the 

International Classification of Functioning, Disability and Health (ICF). It is intended to enhance 

the reader’s understanding of the ICF-based approach to disability measurement. It provides 

guidance for understanding how to collect data regarding disabilities. It also covers data 

structuring, analysis, and dissemination.

Zouris, J. M., Walker, G. J., Dye, J., Galarneau, M. (2006). Wounding patterns for U.S. Marines and sailors 

during Operation Iraqi Freedom, major combat phase. Military Medicine, 171, 246-252.

This study examined the injuries sustained by 279 military personnel who had been wounded in 

Iraq. The goal was to determine the patterns of injuries that were caused by various wounding 

agents. On average, personnel were diagnosed with 2.2 injuries. Open wounds and fractures 

were the most common types of injury. Small arms and explosive munitions accounted for 

approximately 75% of the injuries. Upper and lower extremity wounds accounted for about 70% 

of all injuries. This percentage is consistent with those seen in military conflict since World War 

II, although the anatomical distribution has changed due to advances in personal protective 

equipment.