The United States military has been a medical leader in the treatment of trauma for generations. The absolute necessity of providing rapid and effective treatment to injured soldiers, sailors, airmen and Marines has kept the military on the cutting edge of trauma medicine. This is especially evident with the injury that has been called “the signature wound of the Iraq war”, traumatic brain injury or TBI.
TBI is not just an injury suffered by soldiers in war. The CDC estimates that 1.7 million Americans suffer a traumatic brain injury annually. The Centers for Disease Control offer a layperson’s definition of TBI:
A TBI is caused by a bump, blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain. Not all blows or jolts to the head result in a TBI. The severity of a TBI may range from “mild,” i.e., a brief change in mental status or consciousness to “severe,” i.e., an extended period of unconsciousness or amnesia after the injury. The majority of TBIs that occur each year are concussions or other forms of mild TBI.
There is a growing realization in the medical community that the effects of mild traumatic brain injury are not clearly understood. A mild TBI may produce signs and symptoms for some time after the injury and understanding that mechanism has become a priority for the military.
TBI in the military is usually a result of the patient’s exposure to a blast. Unlike civilian TBI which is usually caused by the head’s collision with another object, the military is exposed to road side bombs and explosions. Blast effects not only move the body and the head around and into other objects, the overpressure created by a blast also has affects.
In an article in the New England Journal of Medicine, January 31, 2008, a study concludes:
Mild traumatic brain injury (i.e., concussion) occurring among soldiers deployed in Iraq is strongly associated with PTSD and physical health problems 3 to 4 months after the soldiers return home. PTSD and depression are important mediators of the relationship between mild traumatic brain injury and physical health problems.
In a recent interview, Kathy Helmick, Interim Senior Executive Director, Traumatic Brain Injury / Director, TBI Clinical Standards of Care Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, spoke with me and other bloggers about the military’s work on TBI. She discussed a change in medical protocols that will impact assessment and treatment for TBI in the field. The U.S. Military is moving from a symptom based approach to an incident based approach.
In effect, if a military unit has been involved in an incident that could produce a TBI, they will now be assessed for that injury without having to report symptoms. The belief is that early detection and early treatment will reduce signs and symptoms of TBI at a later date, according to Helmick.
The Defense Center is also interest in the chemistry involved. Ms. Helmick suggested that the body’s response before, during and after an event that can create a TBI produces a variety of chemical reactions. They are discovering that these biological chemicals in a soldier may differ in number and amount from those produced by an NFL player involved in a tackle. The question to be answered is how these differences affect the TBI and the patient’s recovery from TBI.
Helmick told us that the view at the Defense Center is that mild TBI is a fully recoverable injury, with the cornerstone for recovery being early detection and treatment.
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