Blast Injury and TBI

The war in Iraq will be no different in producing a "signature wound" only this time the wound is in the brains of those affected. Medical experts are witnessing an emerging and significant increase in Traumatic Brain Injury (TBI). In other words, the Iraq war could produce a generation of veterans with life changing brain injury, affecting thousands of service men and women from all walks of life across the country.

During the Vietnam War and the Persian Gulf War, 76 percent of American troops survived combat wounds. But in this century, the U.S. military's surgical teams "have saved the lives of an unprecedented 90 percent of the soldiers wounded in battle…" (New England Journal of Medicine, December, 2006). Furthermore, Walter Reed Army Medical Center has reported that nearly 30% of all patients with combat-related injuries seen at Walter Reed from 2003 to 2005 sustained a TBI and that blast injuries are a significant cause of TBIs In addition, they reported that TBI is often associated with severe multiple trauma, post traumatic stress disorder (PTSD) or undiagnosed concussions. Thus, screening soldiers who are at risk for a TBI is important in order to ensure that TBIs are identified and appropriately treated.

Diagnosis can be difficult even when TBI is apparent or the patient is able to describe a concussive head injury to their doctors. The more common mild brain injury often has more than mild consequences and can cause depression, reduced cognitive functioning, nausea, sleep disturbance, erratic behavior, and mood swings. These impairments are exacerbated by misdiagnosis, lack of treatment and the public’s misperceptions about brain injury and mental illness. For veterans with brain injuries, the lack of physical signs and the diffuse nature of symptoms may be met with skepticism, considered to be psychological, or worse, malingering.

As professionals in the field know, the “walking wounded” do not disappear. And many more will be seen and heard in this decade. Thanks to improvements in protective gear and swift medical treatment, more of America's wounded are surviving - and returning home with serious, permanent injuries. How will these veterans fare in the routines of daily life? Will they be able to maintain employment? How will their injuries impact their families, friends, co-workers, and communities?

The North American Brain Injury Society has begun to address these important issues by devoting a number of educational sessions at our Annual Conference on Brain Injury specifically to address the issue of blast injury. We also recently published a special edition of our quarterly publication Brain Injury Professional that focused solely on blast injury and TBI. NABIS would like to extend our sincere appreciation and thanks to Representative Bill Pascrell, co-chair of the Congressional Brain Injury Task Force, who wrote a thoughtful introduction, and also to Dr. Tina Trudel who served as the issue's Guest Editor.

Concerned by a lack of treatment and service options for brain injury survivors, more than one hundred of the most respected military and civilian leaders in brain injury treatment recently convened at a NABIS organized meeting in Washington, DC, to address the crisis of brain injury in America. The resulting report, Barriers and Recommendations: Addressing the Challenge of Americans with Brain Injury, demands major reforms within the military and civilian sectors. The public release of this report takes a hard-hitting look at available medical care, exposing the grim realities facing Americans with brain injury.

The North American Brain Injury Society welcomes the feedback, comment and support of all Americans seeking to improve the care and treatment of this underserved population. 

Ronald C. Savage, EdD
President, NABIS