PTSD: The Unintended Consequence of War

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Almost daily, we receive reports of the devastating impact of PTSD (Post Traumatic Stress Disorder) on our men and women in uniform and the terrible side-effects on their families and friends.   The US Army is aware of the terrible cost of PTSD as evidenced by the 2010 US Army Report on Health Promotion, Risk Reduction and Suicide Prevention.

Many publications suggest that the origins of PTSD are unknown as evidenced by this recent commentary from a government organization: 

“The cause of PTSD is unknown, but psychological, genetic, physical, and social factors are involved. PTSD changes the body’s response to stress. It affects the stress hormones and chemicals that carry information between the nerves (neurotransmitters). Having been exposed to trauma in the past may increase the risk of PTSD.”

While this may be true, there does appears to be a clear linkage between PTSD and the effects of increasing IED (improvised explosive devices) attacks on US and Allied military forces serving in Afghanistan.   While many believe that PTSD is a psychosomatic discorder, it is becoming increasingly clear that concussion-like head injuries are contributing to PTSD and its debilitating physical and mental consequences.    The US Department of Veteran Affairs estimates that between 11% and 20% of veterans who have served in Iraq and Afghanistan may have PTSD.   If so, this is an alarming number – almost of epidemic proportions.

SFTT has long argued that ill-fitting military combat helmets afforded little protection to our men and women in uniform.  The US Army has been painfully aware of this problem for sometime as evidenced by their decision some years ago to implant sensors in helmets to track trauma related injuries.    Recently, we have been told that a “simple tweak” in the amount of padding in combat helmets would reduce head trauma injuries by 24%.    Why did it take so long to realize we had a serious problem?  More importantly, how long will it take our procurement process to get better protective gear to our troops in the field.

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Helmet Padding may help with PTSD

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The news media is alive with the idea that a “simple tweak” of padding in military helmets will reduce TBI (“traumatic brain injury”) and, perhaps, PTSD (“post traumatic stress disorder”).   Ms. Claudia Cowan of Fox News, published an article on Aril 22nd which suggests that “a little padding goes a long way . . . to provide better protection from blunt force contact.”

Quoting scientists at Lawrence Livermore National Labs, Ms. Cowan suggests that ” by adding just a quarter-inch, or even an eighth of an inch, of padding, helmets had a 24 percent reduction in force to the skull.”

 

“‘When you look at the accelerations that can cause injury, just a small increase in thickness can knock that acceleration down to a point where it’ll make very severe injuries potentially a little less severe, and very light injuries maybe not happening at all,’ explained Michael King, the study co-author and a Lawrence Livermore mechanical engineer.”

 

The yearlong study, funded by the Pentagon’s Joint IED Defeat Organization,  “concluded that the Army’s helmet padding  worked just as well as the padding in NFL, but that there just needed to be a little more of it.”

 

“Concussions among U.S. troops in Afghanistan increased from 62 diagnosed cases in June to 370 in July when the new rules were imposed, according to the U.S. Central Command, which oversees combat here. From July through September, more than 1,000 soldiers, Marines and other U.S. servicemembers were identified with concussions, more than twice the number diagnosed during the previous four months, Central Command says.”

 

While adding more padding may sound like a simple fix, it would require soldiers to wear a helmet one size bigger, and carry additional weight on their shoulders all day.  Helmets normally weigh about 5 1/2 pounds, and a larger size would add about 4 ounces. 

While this appears to be very good news to curb the dramatic increase in PTSD injuries suffered by our troops serving in Afghanistan and Iraq, one wonders why it has taken so long to come up with this “simple tweak.”  More importantly, how long will it take to provide our troops with the additional padding to protect against head injuries.  In fact, some of the articles suggest that the military leadership is reluctant to increase the weight of equipment worn by servicemembers.  Given the critical need to provide better protection for brain injury, it is hard to justify the delay when the “quick fix” adds only 4 oz to the 130 pounds of gear currently worn by servicemembers.

As SFTT has reported on several occasions, the US Army has had sensors embedded in helmets  for well over three years to evaluate brain-related injuries.    What took the US Army so long to come up with the “simple tweak”?  Will it take as long to have the additional padding deployed to our brave heroes?

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MIT study suggests face shields could reduce blast-induced TBI

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A researcher from MIT claims that computer models suggest that face shields added to combat helmets could help reduce blast-induced traumatic brain injury or “TBI” for US military troops serving in combat zones.

Found below is the news release from MIT

QUOTE

MONDAY, NOV. 22, 2010, 3:00 P.M. ET

MIT Study: Adding face shields to helmets could help avoid blast-induced brain injuries

– Researcher releases computer models that show effect of simulated explosions

Simulated Blast Shield

Simulated blast shield (left) and cut-away

CAMBRIDGE, Mass. — More than half of all combat-related injuries sustained by U.S. troops are the result of explosions, and many of those involve injuries to the head. According to the U.S. Department of Defense, about 130,000 U.S. service members deployed in Iraq and Afghanistan have sustained traumatic brain injuries — ranging from concussion to long-term brain damage and death — as a result of an explosion. A recent analysis by a team of researchers led by MIT reveals one possible way to prevent those injuries — adding a face shield to the helmet worn by military personnel.

In a paper to be published Monday in the Proceedings of the National Academy of Sciences, Raul Radovitzky, an associate professor in MIT’s Department of Aeronautics and Astronautics, and his colleagues report that adding a face shield to the standard-issue helmet worn by the vast majority of U.S. ground troops could significantly reduce traumatic brain injury, or TBI. The extra protection offered by such a shield is critical, the researchers say, because the face is the main pathway through which pressure waves from an explosion are transmitted to the brain.

In assessing the problem, Radovitzky, who is also the associate director of MIT’s Institute for Soldier Nanotechnologies, and his research team members recognized that very little was known about how blast waves interact with brain tissue or how protective gear affects the brain’s response to such blasts. So they created computer models to simulate explosions and their effects on brain tissue. The models integrate with unprecedented detail the physical aspects of an explosion, such as the propagation of the blast wave, and the anatomical features of the brain, including the skull, sinuses, cerebrospinal fluid, and layers of gray and white matter.

“There is a community studying this problem that is in dire need of this technology,” says Radovitzky, who is releasing the computer code for the creation of the models to the public this week (for the code, please email: tbi-modeling@mit.edu). In doing so, he hopes the models will be used to identify ways to mitigate TBI, which has become prominent because advances in protective gear and medicine have meant that more service members are surviving blasts that previously would have been fatal.

To create the models, Radovitzky collaborated with David Moore, a neurologist at the Defense and Veterans Brain Injury Center at Walter Reed Army Medical Center, who used magnetic resonance imaging to model features of the head. The researchers then added data collected from colleagues’ studies of how the brain tissue of pigs responds to mechanical events, such as shocks. They also included details about what happens to the chemical energy that is released upon detonation (outside the brain) that instantly converts into thermal, electromagnetic and kinetic energy that interacts with nearby material, such as a soldier’s helmet.

The researchers recently used the models to explore one possibility for enhancing the helmet currently worn by most ground troops, which is known as the Advanced Combat Helmet, or ACH: a face shield made of polycarbonate, a type of transparent armor material. They compared how the brain would respond to the same blast wave simulated in three scenarios: a head with no helmet, a head wearing the ACH, and a head wearing the ACH with a face shield. In all three simulations, the blast wave struck the person from the front.

The analysis revealed that although the ACH — as currently designed and deployed — slightly delayed the arrival of the blast wave, it didn’t significantly mitigate the wave’s effects on brain tissue. After the researchers added a conceptual face shield in the third simulation, the models showed a significant reduction in the magnitude of stresses on the brain because the shield impeded direct transmission of blast waves to the face.

Radovitzky hopes that the models will play a major role in developing protective gear not only for the military, but also for researchers studying the effects of TBI in the civilian population as a result of car crashes and sports injuries. While the study was limited to a single set of blast characteristics, future simulations will study different kinds of blast conditions, such as angle and intensity, as well as the impact of blast waves on the neck and torso, which have been suggested as a possible indirect pathway for brain injury.

Source: “In silico investigation of intracranial blast mitigation with relevance to military traumatic brain injury,” by Nyein, M., Jason, A., Yu. L., Pita, C., Joannopoulos, J., Moore, D., Radovitzky, R. Proceedings of the National Academy of Sciences, 22 November, 2010.

Funding: The Joint Improvised Explosive Device Defeat Organization through the Army Research Office

Contact: Jen Hirsch, MIT News Office

E: jfhirsch@mit.edu, T: 617-253-1682

# # #

Written by Morgan Bettex, MIT News Office

UNQUOTE

SFTT Analysis

Clearly, this is very exciting information and we have to applaud Raul Radovitzky, his fellow researchers and MIT for sharing the computer modeling simulations with the general public.   Brain injuries are receiving considerable attention by the US Army and the Department of Defense and any improvements in combat helmet designs to reduce brain-related combat injuries  is of the utmost importance to troops serving in harm’s way.

SFTT and its supporters have labored long and hard to make sure our troops have the finest protective gear and combat equipment available.  The fact that better protective gear is available or that the technology exists to dramatically upgrade our existing “kit” doesn’t mean that this state-of-the-art equipment will ever be fielded by our troops.   As we have seen time and time again,  the “best” equipment options are often rejected by a military procurement process that operates with stealth-like secrecy and stonewalls Congress and the public on the efficacy of current combat equipment.

The questions we should all be asking ourselves and, most importantly, our military leaders are these:

  • How fast can current manufacturers of combat helmets produce a face shield based on the  “free” computer simulation information provided by MIT?
  • How fast and easily can a “face shield” be added to the Advanced Combat Helmet (“ACH”)?
  • How long would it take for the US Army and DoD to test combat helmet prototypes using  face shields?
  • Assuming the conclusions of the MIT research are confirmed, how soon can we expect US troops to be equipped with helmets using face shields?

This is a real opportunity for the Department of Defense to take the initiative to provide our troops with a state-of-the-art helmet to avoid the increasing incidence of combat-induced brain injuries that now affect well over 100,000 returning veterans.   The time to act is now!

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Medics Improvise to save lives on killing fields of Afghanistan

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In a compelling story published today by the Washington Post, “Military medics combine ultramodern and time-honored methods to save lives on the battlefield” of Afghanistan.

Key Highlights:

  • At 6:09 p.m., Dustoff 57 has just left this base deep in Taliban-infiltrated Kandahar province, headed for a POI, or point of injury. Somewhere ahead of the aircraft is a soldier who minutes earlier stepped on an improvised explosive device, the signature weapon of the wars in Iraq and Afghanistan. All the helicopter crew knows is that he’s “category A” – critical.  The trip out takes nine minutes.  Fifteen minutes have now passed since the soldier was wounded. Speed, simplicity and priority have always been the hallmarks of emergency medicine. The new battlefield care that flight medics and others on the ground practice takes those attributes to the extreme.
  • Four people run to the helicopter with the stretcher holding the wounded soldier. He lies on his back partially wrapped in a foil blanket. His chest is bare. In the middle of it is an “intraosseous device,” a large-bore needle that has been punched into his breastbone by the medic on the ground. It’s used to infuse fluids and drugs directly into the circulatory system when a vein can’t be found. It’s a no-nonsense technology, used occasionally in World War II, that fell out of favor when cheap and durable plastic tubing made IV catheters ubiquitous in the postwar years. Until they were revived for the Iraq and Afghanistan wars, intraosseus devices were used almost exclusively in infants whose veins were too small to find. On each leg the soldier has a tourniquet, ratcheted down and locked to stop all bleeding below it. These ancient devices went out of military use more than half a century ago because of concern that they caused tissue damage. Now every soldier carries a tourniquet and is instructed to put one on any severely bleeding limb and not think of taking it off.
  • Tourniquets have saved at least 1,000 lives, and possibly as many as 2,000, in the past eight years. This soldier is almost certainly one of them. They’re a big part of why only about 10 percent of casualties in these wars have died, compared with 16 percent in Vietnam.  On the soldier’s left leg, the tourniquet is above the knee. The tourniquet on his right leg is lower, below the knee; how badly his foot is injured is hard to tell from the dressings. His left hand is splinted and bandaged, too. Whether he will need an amputation is uncertain. The hospital where he’s headed treated 16 patients in September who needed at least one limb amputated. Half were U.S. soldiers, and the monthly number has been climbing since March.
  • After three minutes on the ground, the helicopter takes off.  Eleven minutes after lifting off from the POI, the helicopter lands at the so-called Role 3, or fully equipped, hospital at Kandahar Airfield, about 30 miles to the east of the also well-fortified Forward Operating Base Wilson. There, surgeons will take care of the injuries before transferring the patient, probably within two days, to the huge military hospital in Landstuhl, Germany, and there, after a week or so, to the United States. It’s been 28 minutes since the helicopter left Forward Operating Base Wilson.

SFTT Analysis:

  • Before every Grunt leaves the wire, they want to know if air or artillery support is readily available and more importantly, if required, will an aerial medevac be responsive – in Joe speak “Time on Target for Air and Arty and a quick Nine-line medevac request . . . how quick will the angels of mercy get here?”.   Quick means quick, the sooner the better obviously, since every minute counts.  Secretary Gates figured this out when he began his battlefield circulation tours in Afghanistan when he became Secretary of Defense and quickly realized that the “Golden Hour”, that period in time that is the standard from time of request for a medevac to arrival at the point of injury and back to medical care on a base, was not being met in Afghanistan due to lack of medevac resources and the distant out-posts that troopers were operating from.  Secretary Gates made it a personal mission to close the gap and ensure that troopers were supported by the “Golden Hour” standard and personally kept the pressure on logistics planners to increase medevac resources and establish medical unit facilities in support of all forward deployed personnel.   The only question SFTT raises regarding this issue is why did it take the Secretary of Defense to correct this situation?  
  • The Washinton Post online article provides a remarkable photo gallery,  – of note is:
    • the destructive nature of an IED that targeted a Mine Resistant Ambush Protected (MRAP).  The simplicity of a pressure plate device loaded with hundreds of pounds of fertilizer (and other components) can defeat US “resistant” vehicles.  More telling is that a device of this size takes time and local support to emplace;
    • grunts not wearing all of their protective gear – no throat, deltoid, or groin protectors – obviously a commanders call, but is the decision not to wear the complete armor suite because of weight and comfort?;
    • the chinstrap for the Advanced Combat Helmet is a flimsy strap of material – no chin pads are provided and the harness is simply used to hold the “brain bucket” in place.  At least the trooper is being medevaced for treatment of a possible TBI.
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Military Helmet Sensor Data: What does it show?

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Two years ago, sophisticated sensors were implanted in military helmets of some 7,000 troops serving in Iraq and Afghanistan.  The purpose of the sensors was to evaluate the extent of concussions and  brain trauma injuries caused by IEDs and other combat related incidents.  According to the military video shown below, data from these sensors was downloaded monthly to a computer terminal  and then forwarded to a “secure” data center in Aberdeen, MD for analysis.

 

To date, SFTT is not aware that the Department of Defense (DOD) has shared any of this information with the public. However, the recent decision by the military to award a new helmet sensor contract to BAE Systems strongly suggests that we are dealing with no trivial issue.  Indeed, the recent release of the comprehensive US Army report entitled Health Promotion Risk Reduction Suicide Prevention and increased media attention at the extent of brain trauma injuries within the military would argue that greater public disclosure is well-advised to deal with this growing problem.

As recent history shows, the US Army and DOD are unwilling to share relevant data with the public that might suggest that the equipment provided to our brave warriors is deficient.   In fact, Roger Charles, the Editor of SFTT, was obliged to file a request under the Freedom of Information Act (“FOIA”) to obtain forensic records of troops killed with upper torso wounds to evaluate the effectiveness of military-issue body armor.   A  federal judge in Washington, D.C. recently ordered the Army’s medical examiner to release information about the effectiveness of body armor used by U.S. soldiers in Iraq and Afghanistan or to justify the decision to withhold it.  For Roger Charles and those in SFTT who have followed this issue for several years, it is unlikely that the US Army will open their kimono and confirm what most already know:  the body armor issued to our troops was not properly tested and is most likely flawed.

Full disclosure is generally the “right” decision and it would be useful for the US Army to share the helmet sensor data with the public to help address a growing problem for the men and women who have served in harm’s way and their families.   The American public can handle the truth!

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Brain Trauma Injuries and A.L.S.

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In a paper released this week, there are new indications that brain trauma injuries may mimic many of the symptoms of Lou Gehrig’s disease.  In an news article published August 18th by the New York Times entitled Brain Trauma Injury can mimic A.L.S.,  NYT’s reporter Alan Schwartz indicates that A.L.S. or amyotrophic lateral sclerosis, commonly referred to as Lew Gehrig’s Disease may have been triggered by concussions and other traumatic head injuries. 

According to the New York Times report, “Doctors at the Veterans Affairs Medical Center in Bedford, Mass., and the Boston University School of Medicine, the primary researchers of brain damage among deceased National Football League players, said that markings in the spinal cords of two players and one boxer who also received a diagnosis of A.L.S. indicated that those men did not have A.L.S. They had a different fatal disease, doctors said, caused by concussion-like trauma, that erodes the central nervous system in similar ways.”

As previously reported by SFTT and other reliable sources, the military is paying far greater attention to brain trauma injuries and its long-term effects on military personnel if left un-diagnosed.    Officially, military sources place the number of troops suffering from brain trauma injuries at 115,000, but informed sources place the number much higher.    Clearly, the  rapid deployment of new helmet sensors by BAE based on preliminary field studies suggests that is a serious problem that is attracting the attention of our military leadership.

While pleased brain injuries caused by frequent I.E.D incidents is receiving more careful diagnosis and serious medical study, the question remains:  Do our troops have the best protective gear and military helmets to cushion the immediate effects of an I.E.D. explosion?  Simply deploying our troops with sensors to “study” the effects of brain trauma injury is akin to a laboratory experiment with rats.  More succicntly, is there currently a better alternative to the current standard-issue military helmet that would help reduce brain trauma injury.

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New Helmet Sensor to detect Traumatic Brain Injuries

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BAE Systems unveiled its latest concussion sensor for soldier helmets, named Headborne Energy Analysis and Diagnostic System (“HEADS”).  Reportedly, about 7,000 1st generation sensors have already been installed in helmets of U.S. military warriors.   The new devices feature much more effective reporting capabilities that will hopefully help in getting medical attention quicker to those that need it.

The HEADS smart sensor is also designed to provide medical professionals with important data that may help determine the severity of a possible traumatic brain injury (“TBI”). The second generation HEADS sensor reportedly provides medical teams with a valuable diagnostic tool that utilizes radio frequency technology.   Spokesperson Colman claims that “With our new ‘smarter’ sensor, if a soldier is exposed to a blast, possibly sustaining a concussion, not only will the HEADS visual LED display be triggered at the time of the event, but once the soldier enters a specified area, such as forward operating base or dining facility, a series of strategically placed antennae will scan all available HEADS units and send data to a computer, identifying any soldiers who may have sustained a blast-related brain injury.”

The sensor itself is small, lightweight and can be secured inside virtually any combat helmet. Although imperceptible to the wearer, it is designed to continuously collect critical, potentially lifesaving data, including impact direction, magnitude, duration, blast pressures, angular and linear accelerations as well as the exact times of single or multiple blast events. That information is then securely stored until it can be quickly downloaded and analyzed by medical teams using a simple USB or wireless connection.

Compatible with most helmets, the HEADS sensor is unobtrusive and won’t interfere with additional helmet-mounted equipment soldiers may need, such as goggles and other sensors.

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Is the military covering up the extent Traumatic Brain Injury?

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In an explosive new report by ProPublica and National Public Radio (“NPR”) it would appear that the US military is seriously underestimating the brain damage or traumatic brain injury (“TBI”) caused by roadside bombs.   Officially, the military claims that 115,000 troops have suffered “mild” TBI, although ProPublica and NPR claim that “unpublished military reports” place the number much higher.

T. Christian Miller, ProPublica, and Daniel Zwerdling, NPR,   examined government records, previously undisclosed studies, and private correspondence between senior medical officials and conducted interviews with scores of soldiers, experts and military leaders.  Among their findings:

  • Military’s doctors and screening systems “routinely miss brain trauma in soldiers. One of its tests fails to catch as many as 40 percent of concussions, a recent unpublished study concluded.  A second exam, on which the Pentagon has spent millions, yields results that top medical officials call about as reliable as a coin flip.”
  • “Even when military doctors diagnose head injuries, that information often doesn’t make it into soldiers’ permanent medical files. Handheld medical devices designed to transmit data have failed in the austere terrain of the war zones. Paper records from Iraq and Afghanistan have been lost, burned or abandoned in warehouses, officials say, when no one knew where to ship them.”
  • “Without diagnosis and official documentation, soldiers with head wounds have had to battle for appropriate treatment. Some received psychotropic drugs instead of rehabilitative therapy that could help retrain their brains. Others say they have received no treatment at all, or have been branded as malingerers.”

Maj. Remington Nevin, an Army epidemiologist who served in Afghanistan is quoted in the article as saying, “It’s obvious that we are significantly underestimating and underreporting the true burden of traumatic brain injury. “This is an issue which is causing real harm. And the senior levels of leadership that should be responsible for this issue either don’t care, can’t understand the problem due to lack of experience, or are so disengaged that they haven’t fixed it.”

Lt. Gen. Eric Schoomaker, the Army’s most senior medical officer, allegedly instructed local medical commanders not to speak to ProPublica and NPR.  He apparently emailed bases that “We have some obvious vulnerabilities here as we have worked to better understand the nature of our soldiers’ injuries and to manage them in a standardized fashion. I do not want any more interviews at a local level.”    Neverthelss, Lt. Gen. Schoomaker later  “acknowledged shortcomings in the military’s diagnosing and documenting of head traumas.   “We still have a big problem and I readily admit it,” said Schoomaker, the Army’s surgeon general. “That is a black hole of information that we need to have closed.”

“The long-term effects of mild traumatic brain injuries can be devastating, belying their name. Soldiers can endure a range of symptoms, from headaches, dizziness and vertigo to problems with memory and reasoning. Soldiers in the field may react more slowly. Once they go home, some commanders who led units across battlefields can no longer drive a car down the street. They can’t understand a paragraph they have just read, or comprehend their children’s homework. Fundamentally, they tell spouses and loved ones, they no longer think straight.”

Clearly, the extent of brain injuries are extremely difficult to diagnose and particularly so under battlefield conditions.  Nevertheless, there is mounting evidence that our brave frontline troops are not receiving a proper diagnosis and timely and adquate treatment for this crippling affliction.   SFTT applauds T. Christian Miller of ProPublica and Daniel Zwerdling of NPR for their thorough investigative reporting.

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BAE Helmet Sensor Contract a Step in the Right Direction

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BAE Systems has received an initial order of $17 million from the U.S. Army for Headborne Energy Analysis and Diagnostic Systems (“HEADS”) to help address combat-related traumatic brain injuries(“TBI”), which according to many medical professionals are becoming a signature injury of the Iraq and Afghanistan wars.   BAE is one of two military contractors who has received such a contract with a maximum contract award value of $105 million.

According to the news release, the HEAD’s sensor system is “designed to better monitor soldiers and help identify their risk levels for combat-related TBIs, BAE Systems introduced its HEADS sensor to the military in 2008. Since then, nearly 7,000 of the company’s HEADS units have been fielded to the U.S. Army and U.S. Marine Corps . . .”

While this appears to be good news given the increased media focus on TBI-related injuries, it would be most useful if the DOD could share information with the public on the data it collected over the last two years based on the 7,000 units that have already been fielded.  Presumably, there is enough information from this sample testing to award a $105 million contract.  SFTT makes this simple request, since Dr. Charles Hoge, the U.S. Army’s senior mental health researcher at Walter Reed Hospital from 2002 to 2009 and now advisor to the Army Surgeon General, wrote an interesting piece for the Huffington Post in which he effectively dismissed the idea that there might be lingering effects from mild traumatic brain injury (“TBI”).

Is Dr. Hodge yet another case of a military spokesperson “sugar-coating” or “quibbling” over the effects of traumatic brain injury because of improper helmet design or is there something more sinister the military leadership is hiding?  Why the sudden rush to extend the use of sensors to track TBI?   With the recent recall of military helmets and Dr. Hodge’s lame defense of troops with “mild” TBI, one suspects that there is strong reason to be concerned that our troops don’t have the “proper” headgear and are not likely to have any too soon since the new HEAD’s sensors won’t be available until July, 2011.   While this may allow us to treat TBI injuries more quickly, it does little to determine whether our troops have the best available headgear.

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Military Helmets: Traumatic Brain Injury

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Dr. Charles Hoge, the U.S. Army’s senior mental health researcher at Walter Reed Hospital from 2002 to 2009 and now advisor to the Army Surgeon General, wrote an interesting piece for the Huffington Post in which he effectively dismissed the idea that there might be lingering effects from mild traumatic brain injury (“TBI”).    This article appears to have written to place the US Army “spin” on earlier report from the New York Times that a US Army survey of 18,000 soldiers suggested that 40% of returning soldiers had “experienced at least mild TBI.”   Could it be that our antiquated military helmets should have provided better protection to prevent these cases of TBI?

While Dr. Hoge recommends that we should honor these brave but impaired heroes, he goes on to argue that there is no easy clinical or pychological explanation to determine the degree of TBI.  In fact, he goes on to suggest that we re-label these conditions to produce an “AC” or Army-Correct version.  According to Dr. Hoge, “medical and mental health professionals can better educate their warriors about combat physiology, and not make everything so clinical. Instead of ‘trauma,’ ‘injury,’ ‘symptom’ or ‘disorder,’ they can try using words like ‘experience,’ ‘event,’ ‘reaction’ or ‘physiological responses.’ That doesn’t minimize the importance of medical terminology, especially in guiding effective treatment, but it also acknowledges the warriors’ need for validation of their own experiences.” 

This callous “spin” suggests that if we call the symptoms or evidence of TBI something else such as Post Traumatic Stress Disorder (“PTSD”) then we have a psychologically treatable “reaction” to high levels of stress rather than a physical ailment.  This is sophistry at its best.

Many have long argued that our troops need state-or-the-art liners and self-adjusting padding inside military helmets to cushion or dissipate the energy of a hit that lessen the sudden movement of the head that causes concussions.   Why can’t our brave soldiers be afforded the same level of protection that we give to NFL and college football players?  The technology is available if only the US Army would care to look rather than staunchly defend the safety of current military helmets.

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