Bomb blasts, falls have same effect on brain

[thedrifter]

Bomb blasts, falls have same effect on brain
By Kelly Kennedy - Kellykennedy@militarytimes.com
Posted : August 13, 2007

Experts studying traumatic brain injuries have come to a surprising conclusion about head injuries from bomb blasts and from car accidents or falls: They’re basically the same.

“The brain just knows it’s bleeding,” said David Cifu, who oversees the traumatic brain injury program at the Department of Veterans Affairs Medical Center in Richmond, Va.

Because explosives are the weapon of choice for insurgents in Iraq, and because their force tosses bodies about like dolls, the services are seeing many more head injuries than in past wars.

Theories abound about blast- pressure waves causing tiny bubbles to form after passing through a brain, or compression of air in the lungs causing an injury in the brain. Some have even suggested mild traumatic brain injuries from blasts are somehow less harmful than those caused by a bump on the head.

But Cifu said current research shows that blast waves cause the same symptoms, heal over the same amount of time and should be treated the same way as any head injury.

“They look the same” as head injuries from sports or car accidents, he said. “We’re comparing apples to apples.”

If pressure waves were really passing through the skull, “you’d see lost eardrums and blown-out eyeballs,” Cifu said.

But that doesn’t mean the blasts are not causing injuries.

Ronald Glasser, who was an Army doctor in Vietnam and is author of “Wounded: Vietnam-Iraq,” said the blast from an improvised explosive device moves at 13,000 mph, gets as hot as 7,000 degrees and creates 400 tons of pressure per square inch.

“No one survives that,” Glasser said. “We’re trying to save the kids at 25 meters and beyond.”

Beyond that range, Glasser and Cifu said, injury results from the power of the blast hitting the skull like spray from a fire hose.

“The pressure is throwing their head back really fast,” Cifu said. “That rapid acceleration and deceleration appears to be causing the injury.”

The wave creates a two-strike blow: If it hits the back of the head, the brain slams the front of the skull, which then snaps back, causing the back of the brain to hit the rear of the skull.

Add to that the possibility of an overturned vehicle, flying debris and the general chaos of a roadside bomb attack, and it’s hard to tell what caused the injury, said Col. Jonathan Jaffin, head of the Army Medical Research and Materiel Command.

“In most such cases, all these things happen at once, so it’s hard to tell what the mechanism was,” he said. “But there’s no evidence that overpressure causes a brain injury.”

In April, the military rolled out a standardized treatment plan for the top 22 symptoms of traumatic brain injuries, based on years of research of civilian head injuries, Cifu said.

“The symptoms are the same,” said Barbara Sigford, director of the VA’s Physical Medicine and Rehabilitation Service. “And there’s no reason to believe [the standard treatment] is not just as effective.”

Ellie

[thedrifter]

Experts: Even mild head injuries put troops at risk
By Kelly Kennedy - kellykennedy@militarytimes.com
Posted : August 13, 2007

Within days of falling 15 to 20 feet off a sand berm on the Kuwait-Iraq border and landing on his head in Iraq, Army Master Sgt. Jos� Santiago realized his soldier skills had also taken a dive.

He began shirking his duties because he couldn’t trust himself to do them right. He forgot words and used expletives instead. And he sheepishly copped to the ultimate warrior sin: “misplacing” his weapon.

“I tried to suck it up and drive on,” he said.

But when his team took sniper fire in Karbala, the concussion that made him forgetful and angry also made his left arm go numb. “I couldn’t move, couldn’t reach for my weapon,” he said.

Experts say troops operating with head injuries — even slight concussions — put themselves and their buddies at risk.

“Concussion may impair the combat-effectiveness of soldiers ... poor marksmanship, delayed reaction time, decreased ability to concentrate and inappropriate behavior that lasts for several days,” reads a July 2006 All Army Activities message.

A series of studies on athletes at the U.S. Military Academy at West Point, N.Y., has worked out just how long people need to avoid reinjury based on tests that show cadets’ cognitive skills can take days to return to normal, even after headaches, dizziness and numbness have dissipated.

For that reason, any cadets who lose consciousness or show any symptoms are pulled from their sport until the symptoms vanish. Then, depending on the severity of the injury and the number of previous head injuries, they get benched for a few days, or possibly the rest of the season. Failing to err on the side of caution, studies show, raises the risk of long-term symptoms — or even death.

At the academy recently, 20 cadets watched their classmates go at it in the boxing ring.

“Why are you holding back?” yelled their coach, Army Capt. Dennis Terry. “You move straight back, he’s gonna find you all day.”

But Terry was on the watch for more than technique. As a glove slammed into a temple, he yelled again. “No more power shots to the head — either of you!”

Later, he explained, “If we have a closed-head injury, one right after another, we know there’s trouble. We work really hard to stop it. Some of these kids would just keep hitting.”

Terry said the military is coming to understand that troops don’t “shake off” concussions.

Karen Peck, assistant athletic trainer and instructor, said young people with head injuries who suffer a second such injury before symptoms of the first are gone — “second-impact syndrome” — have a 50 percent mortality rate.

“The vascular system dilates, and the brain bleeds to death,” she said. “It happens really fast.”

And someone who has had a head injury — no matter how long ago — is more likely to incur a second injury, she said.

At the end of class, 20 cadets lined up across from each other for a “buddy check.” They made sure the other guy wasn’t reeling, that his pupils were the same size, that he wasn’t dizzy. This drill, Terry noted, could easily be done after every patrol in Iraq.

Studies show that instant death is not the only risk that comes with multiple mild head injuries. They can cause permanent short-term memory loss, stuttering, inability to perform basic math or reading tasks, and behavioral problems. Recent studies also show that repeated head injuries boost the risk of Alzheimer’s disease later in life.

But making people understand what “head injury” means can be difficult. “People say, ‘I’ve been knocked unconscious a few times, but I’ve never had a concussion’ � that’s a concussion,” Peck said.

Any loss of consciousness — no matter how brief — is a head injury. But in the chaos of an improvised explosive device explosion, people often don’t remember if they’ve passed out. They only know they feel dizzy, have tunnel vision, a headache, ringing in the ears.

Even with the symptoms, troops don’t always speak up. “They want to keep going,” Peck said.

As if to prove her point, cadets Michael Benedosso and Reggie Smith spoke of a pal who, after a bout, kept repeating things. “He seemed normal at first, but the more you talked to him, the more you realized he wasn’t OK,” Benedosso said.

But even as Benedosso said his West Point training would help him look for head injuries among his troops if he goes to Iraq, he made an admission: “I’ve felt woozy or the entire right side of my body will go numb. I just got caught with a good shot to the head. But I didn’t tell anybody because they would have pulled me out.”

But that would be the best medicine, doctors say.

David Cifu, who oversees the traumatic brain injury program at the VA medical center in Richmond, Va., said it’s best to remain far from potential vehicle accidents and explosions for up to a week after a head injury.

“The clock starts when they’re no longer symptomatic,” Cifu said. “But there’s a concern that would take all of our people out of the fight.”

He said military officials talked about how to handle head-injured troops at a May summit. “Maybe, if there’s one hour of symptoms, you spend 25 hours out of the fight,” he said, talking about one option that was discussed.

The Defense and Veterans Brain Injury Center at Walter Reed Army Medical Center in Washington, D.C., began sending boxes of literature to medics, doctors and commanders on the front lines in early June, he said, adding that defense officials are “very aware” of the West Point studies.

Col. Jonathan Jaffin, chief of the Army Medical Research and Materiel Command, said he understands that troops don’t want to let their buddies down by being pulled out of the fight.

But by staying in, he said, “they’re not helping as much as they think they are.”

Ellie