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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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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Absentee Leadership in DC and Afghanistan: Frankly ma’am, I don’t give a damn!

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In an enlightening article on the current lack of leadership in DC and the killing fields of Afghanistan,  Leslie H. Gelb reports on the opening of a new medical facility in Bethesda, Maryland (near DC)  to treat active-duty soldiers and veterans suffering from brain injuries and psychological disorders. Unfortunately, this article is not about the brave men and women and their families who were on hand for the innauguration of this long overdue facility, but about those who chose not to attend.  I quote at length from Mr. Gelb’s eye-opening article published in the Daily Beast:

“It was inauguration day for the nation’s most modern facility for the treatment of active-duty soldiers and veterans suffering from brain injuries and psychological disorders—5,000 of them with families on hand. At the podium in Bethesda, Maryland, stood Arnold Fisher, the chief fundraiser for this precious center that may need to care for hundreds of thousands of victims, searching in vain for one White House official, one Cabinet officer, one member of the Joint Chiefs, one senator. He found none. And he asked again and again, ‘Where are they?’

“‘You are injured,’ Fisher said. ‘We are all here. Where are they?’

“Where were they? President Obama was in meetings and having a hamburger lunch with Russian President Medvedev. Secretary of State Hillary Clinton was also at these meetings, though not at the hamburger shop in Virginia. Michelle Obama, who has made caring for military families one of her top priorities, couldn’t make it; she was said to have given her final “no” at the last minute. She was accompanying Mrs. Medvedev on a visit to the Duke Ellington School for the Arts in D.C., where they watched a dance performance. Vice President Joe Biden also met with Russians and with Israelis. Defense Secretary Robert Gates sent his deputy William Lynn III. All four Joint Chiefs sent their deputies. General Eric Shinseki, secretary of Veterans Affairs, couldn’t make it. Not one among the legions of pro- and antiwar hooting senators could find the time. Only two members of the House of Representatives found their way to the ceremony.”

“But there was Fisher at the podium. A corporal in the Korean War, Fisher is now a successful real-estate developer, builder, and philanthropist. He avoids confrontation and the limelight, but he could not suppress his dismay about the absences that inaugural day. ‘Here we are in the nation’s capital, the seat of our government, the very people who decide your fate, the people who send you out to protect our freedoms. And yet, where are they?’  he asked the attendees. ‘And while we appreciate that much of our military leadership is present, our government should be behind this effort,’ he continued. ‘I know these are difficult times. I read newspapers. I see the news. And still, where are they? They call you out. You are injured. We are all here. Where are they?'”

Indeed, “Where are they?”   Where are the leaders with the conviction, integrity and proper sense of values that would not take the time to reach-out and honor those who have given so much for our country?  Our leaders and media assail the Chairman of BP when he refers to the “little people” of Louisiana, but what message does it send to our troops and their families when a hamburger photo-op with Russian President Medvedev is more important to our Commander in Chief than attending the innauguration to salute our heroes.  In fact, both Russia and the US have spilled blood in Afghanistan and it might have served a useful purpose if both Presidents had attended to reflect on the consequences of sending  young men and women to war.

It would appear that these brave heroes are treated as little more than disposable assets to further  foreign or military policy goals that few can articulate and even fewer understand.   Surely, our troops deserve better.  Let’s give our troops the leadership they deserve or, perhaps, those desk-bound military and civilian “leaders” should just pull a Clark Gable and tell grieving mothers:  “Frankly ma’am, I don’t give a damn!”

Richard W. May
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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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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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