2010 Congress: The Services and the “Signature Wound”

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Sure, “Bloody Sunday” shows sports helmets need fixing. But what still resonates for me is the shocking state of our young warriors’ helmets and the little attention paid to the “Bloody Days” everyday in Afghanistan and Iraq.

The key issues of course are what’s being done to prevent these egregious combat-related head injuries and exactly who is responsible?

Our senior military leaders?  Congress?  A combination of both? 

If you Google “TBI congressional hearings” you get 23,000 hits, the majority of which confirm that the Congressional focus is on sports-related head injuries versus combat-related head injuries (aka Traumatic Brain Injury).

If you Google “TBI the signature wound of the wars in Iraq and Afghanistan” you get 14,000 hits, demonstrating that the majority of policymakers and military leaders have actually done very little. In fact, it’s pretty much just the same old standard boilerplate lip service.

That’s because Congressional hearings simply don’t materialize out of thin air.  Oftentimes, a current event or failed policy will cause legislators to call for a hearing.  But unless there’s a constituency with well-connected “K” Street lobbyists, the committee staff will routinely develop a reactive schedule of hearings to support legislative priorities on the radar-screen within their respective committees to consider relevant testimony as they prepare to leverage pending legislation.

This year alone there have been six congressional hearings related to head injuries – four on sports-related head injuries and two on combat-related injuries. 

One of the two Congressional hearings before the Senate Armed Services Committee included TBI.  However, the TBI topic and witnesses were added to a previously scheduled hearing only after Pro Publica reported on the inadequate policy attention given TBI which alerted Chairman Levin to the problem.  In other words TBI hadn’t been scheduled –and the lesson learned is that it often takes either lobbying or the spotlight of investigative reporting to prompt Congressional action. The squeaky wheel syndrome.

What these six hearings do reveal however is that the sports-related injury hearings focused on a combination of prevention (i.e. improving equipment) and treatment (specifically the impact these injuries have on physiology, including motor skills, long term brain damage and cognitive rehabilitation), while the combat injury related hearings were solely concerned with treatment of TBI—with nary a mention of prevention such as improving the equipment.

The point is that after almost a decade of sustaining gruesome head injuries in combat there is little-to-no congressional focus on prevention of these injuries.  I’m not talking about the tactics, techniques and procedures of defeating the IED threat—which is a completely different argument and issue—but actually improving the combat helmet! 

 So why is the focus on treatment, not prevention?  My best guess is that the Services continue to follow the Code of Silence and do very little to actually schedule or focus Congress to fix this problem.  After all, in a culture where anyone who comes forward pays a harsh price, why volunteer to air dirty laundry in such a public forum?

So what does happen when the Services are called before committees to answer uncomfortable questions, since they’re not about to raise their hands on their own? 

Our sources have confirmed that each Service and their legislative liaisons fight tooth and nail to:

  • Control every witness (i.e. reduce the rank of the witness – less liability at the top);
  • Submit reports past their due dates (i.e. drag heels on timeliness and blame the bureaucracy): and,
  • Short-change statements in order to minimize exposure and keep a tight lid on policy (i.e. release prepared remarks and statements to committees at the last possible moment).

So if the Services are unwilling to own up to the problem and make prevention the priority, is there anywhere in the public record where military leaders have focused on replacing the Advanced Combat Helmet as opposed to after-the-fact treatment? 

The tragic answer is no.

A cursory review of each Service’s Annual Posture Statements confirmed more focus on treatment, but little to none on prevention:

  • The Chairman of the Joint Chiefs briefly mentions “treating the hidden wounds of war” in his statement.
  • The Army Chief of Staff didn’t even mention TBI. Seriously, has this man been to Walter Reed lately?
  • The Commandant of the Marine Corps does better than his Soldier counter-part and

    reported that the Corps has a formal screening protocol for Marines who suffer concussions or who are exposed to blast events in theater and that Naval medicine remains at the forefront of researching and implementing pioneering techniques to treat traumatic brain injury.

  • The Chief of Naval Operations reported that Navy Medicine has reached out to its civilian colleagues and established partnerships with civilian hospitals to improve the understanding and care for those affected by traumatic brain injuries. 
  • The Chief of Staff of the Air Force made no mention what so ever of TBI  “signature wounds.” 

Finally, I briefly mentioned that hearings beget legislation and appropriations.  So what are the fruits of the legislative labor in regards to directing and funding prevention? The committee notes that the Army is accelerating research and development of materials to increase personal protective equipment while reducing its weight. They recommend an increase of $3.0 million (in Program Element 64601A ) for next-generation helmet ballistic materials technology (2010 National Defense Authorization Act Committee Report). Chump change to the Military Industrial Congressional Complex, an insult to America’s frontline troops—and a confirmation of the sad fact that sometime, somewhere prevention will be addressed only if an organization such as ours starts applying the necessary pressure.

Yet right now, more than a week after the NFL’s “Bloody Sunday,” I guarantee you that league leaders, owners and investors are making detailed plans to spend hundreds of millions of dollars redesigning helmets and gear, revamping training and keeping players accountable for violating policies – all to protect their human investment. And how do they plan to do that?  By preventing further injuries to their players in the first place.

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Bloody Sunday: 16 (US Troop Casualties) vs. 6 (NFL Player Casualties)

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 I follow football.  High School, College, Professional – all levels, all kinds. It’s a blood sport.  So there was no way I could ignore the blaring RSS feed headlines on Monday morning announcing that this past weekend’s games will be forever known as “Bloody Sunday.” Sports Illustrated football analyst Peter King reported that “Last Sunday could go down as a seminal moment in NFL history,” because of the injuries sustained on the playing field and the impact on future play, rules and equipment.  The Vice President of Operations for the NFL, Ray Anderson, said that “We’ve got to protect players from themselves” as a result of the violent day.

I also follow the war and the troops.  You know, the ones who allow us to watch sports on weekends without having to worry about some mushroom cloud or Mumbai-style attack here on American soil.  The ones out there protecting that freedom thing, right? 

But, “Bloody Sunday” in the NFL?  Six vicious and violent hits?  Four concussions?  A couple of broken bones?  Oh, my . . . especially compared to how “Bloody” it was in Afghanistan last week.  And compare the changes the NFL is making for head injuries sustained by players, to DOD’s lack of concern for frontline troops.

Since January 2010, on average, 15 troops have been wounded in Afghanistan every single day.  Every. Single. Day. Period.  Simply put, that’s a lot of bloody days.  This past Sunday, there were 15 wounded troopers, and sadly, one killed in action; that equals 16 casualties.  Bloody indeed!  But maybe last Sunday in Afghanistan was simply a bad day, so for some perspective, let’s add up all the casualties from last week.  On average, there were over 100 troopers wounded in action, and 18 US service members paid the ultimate sacrifice and were killed in action.  15 deaths resulted from IED strikes, and 3 deaths resulted from hostile fire.  Of the 15 deaths resulting from IED strikes, 4 were killed in one vehicle, 3 were killed in another, and 2 were sharing another vehicle when they were killed by IED’s.[1]  Statistics that detail the type and extent of the more than 100 wounds suffered are not available (or accurate).  However, we can pretty safely assume that the troopers that survived IED blasts in Mine Resistant Ambush Protected (MRAP) vehicles suffered some type of mild-to-severe brain injury—or at the least were concussed—and  that these injuries clearly outpaced those suffered by football players last week. 

I’m comparing head trauma in football and combat, because everyone involved is wearing a helmet.  And if on a given Sunday, the spike in head trauma injuries prompts immediate change in policy and a new commitment to equipment upgrades by the NFL—but not the Department of Defense—then it seems to me that we should all take notice.

So what actions did the NFL take? The concern from head injuries and concussions forced the NFL to impose huge fines on three players this Tuesday for dangerous and flagrant hits and warned the league that violent conduct will be cause for suspension.  It only took the NFL 48-flipping-hours!  And I guarantee that helmets, padding, chinstraps, buckles, screws and straps for every single NFL football helmet is being inspected by equipment maintenance personnel and will be carefully repaired, replaced or some new whiz-bang safety component will be added.  I also guarantee that any and all big-contract players who suffered the slightest head injury have received top-shelf medical care and will most likely be forced to sit out a game or two to protect their team’s “investment.”

So what was the response from the Pentagon after last week’s bloody fray in Afghanistan?  Not a peep except to update the casualty data base and keep issuing sub-standard Advanced Combat Helmets to troops.   From what the troops report to SFTT, some troops obviously get Medevac’ed out of theater due to the severity of their injuries; but some don’t.  And for those who weren’t, maybe the mission profile will allow them to take a one-day or two-day respite from being outside the wire.  But probably not, in line with the old adage, “Every man strengthen the north wall.”  Most ludicrous is the appalling fact that no comparison can be made between frontline troops and NFL players regarding the quality of available medical care, the amount of investment in science and technology to improve the equipment and the commitment to provide long term treatment for traumatic brain injuries.  Must be nice to play in the NFL, and that is the bloody truth!


[1] Department of Defense and icasualties.org data.

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