By Marilyn Lash, M.S.W.

Lash and Associates Publishing/Training Inc.

Traumatic brain injury and blasts in the military

Soldiers in Afghanistan and Iraq have been exposed to frequent blasts with the use of improvised explosive devices (IED). Both civilians and military personnel can be targeted or caught in an explosion. It is estimated that as many as 47% of all blast injuries affect the soldier’s head (Suh, Sarkar, Kolster, Drexel, & Ghajar 2007). Despite this high number, some brain injuries are not diagnosed because there may be no external sign of injury.

As recently as 2006, the Office of the Surgeon General of the Army noted that 64% of wounded in action injuries were caused by IEDs, rocket propelled grenades, land mines and mortar/artillery shells. Even with improvements in helmet design and body armor, blast related closed head injuries have become known as the signature injury of Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) which includes Afghanistan (Trudel, Davanzo, Mattingly, Nidiffer, & Barth, 2007).

What is a blast injury?

Just as the severity of a brain injury can range widely from very minor to extremely severe in the civilian population, this also applies to blast injuries among the military. But service members are exposed to additional risks of damage from the blast’s impact, being thrown or propelled by the blast, possible burns and inhalation of toxic substances (Suh et al., 2007).

There are different types of blast injuries.

• Primary blast injuries Organs are damaged by the wave of changes in atmospheric pressure that follows the blast.
• Secondary blast injuries The service member is hit by objects put into motion by the blast.
• Tertiary blast injuries Service members are injured by being thrown or put into motion from the blast.
• Quaternary blast injuries Service members are burned or inhale gases from the blast (Ziejewski, Karami & Akhatov, 2007).

The brain is especially vulnerable to secondary and tertiary blast injuries. An explosive material, such as TNT, is used to create a blast. The damage that can be caused depends largely on the weight of the explosive charge and the distance between the source of the blast and the target. Once a mass of TNT is detonated, the pressures of the shock wave can build as it meets objects or structures in its path. This is known as a reflection factor and it can become even stronger than the original force (Ziejewski et al., 2007).

PTSD in the military

Every person responds differently when exposed to the physical and emotional trauma of wartime combat. Reactions are influenced by age, gender, previous exposure, personality, and the nature of the trauma. Continuous exposure to violence and dangerous situations can result in stress related disorders with physical symptoms and cognitive and behavioral changes (Nidiffer, Errico, Trudel & Barth, 2007).

Post Traumatic Stress Disorder (PTSD) has long been known to occur in the military as a consequence of combat exposure. A recent study among military personnel deployed to Iraq found that the incidence of PTSD increased by the number of firefights soldiers encountered. The study also found that 15-17% of military personnel met the criteria for major depression, generalized anxiety or PTSD after duty in Iraq. The same finding occurred in 11% after duty in Afghanistan (Nidiffer et al., 2007).

The importance of the military screening for psychological conditions is clear. This same study found that 9% of the military personnel involved had one of these diagnoses prior to deployment. Rates of PTSD increased more than any other condition when pre and post deployment data were examined (Nidiffer et al., 2007).

Traumatic brain injury and PTSD

The combination of these two diagnoses can be devastating for service members and their families and must be treated together. Common brain injury symptoms such as fatigue, agitation, distractibility, lower attention and mood swings can interact with PTSD symptoms to create an intolerable situation for service members and their families (Nidiffer et al., 2007). Much more research is needed to develop effective treatment strategies for military members, particularly as they make the transition from active duty to civilian life.

References

Nidiffer, F, Errico, A, Trudel, T, and Barth, J. (2007). Current Trends in Post Traumatic Stress Disorder and Traumatic Brain Injury among Military Personnel. Brain Injury/ Professional 4:1(26-29).

Suh, M., Sarkar, R, Kolster, R, Drexel,P & Ghajar, J. (2007). New Ways to Diagnose and Assess Attentional and Cognitive Deficits following Blast Injury. Brain Injury/ Professional 4:1(18-19).

Trudel, T, Davanzo, J, Mattingly, E, Nidiffer, D, & Barth, J. (2007).Reintegrating Military Personnel after Traumatic Brain Injury (TBI): A community integrated rehabilitation model in practice. Brain Injury/ Professional 4:1(22-25).

Ziejewski, M, Karami, G, & Akhatov, I. (2007). Selected Biomechanical Issues of Brain Injury Caused by Blasts. Brain Injury/ Professional 4:1(10-14).

Recommended reading

This Fact Sheet is based on the special issue of Blast Injury and TBI of the Brain Injury/Professional (vol. 4, issue 1), 2007.

Brain Injury/Professional is the largest professional circulation publication on the subject of brain injury and is the official publication of the North American Brain Injury Society (NABIS). Members of NABIS receive a subscription as a benefit , go to  www.nabis.org

Understanding the Effects of Concussion, Blast and Brain Injuries

Blast injury, PTSD and brain injury guide for families and caregivers on the consequences of concussion in veterans. Used by many VA Hospitals, Military Hospitals and Vet Centers. 

The PTSD Workbook 

By Mary Beth Williams, Ph.D., LCSW, CTS and Soili Poijula, Ph.D. 

Workbook on symptoms and consequences of PTSD after blast injury, concussion and brain injury with exercises for coping and reducing stress amd symptoms.

Down Range to Iraq and Back   

By Bridget Cantrell, Ph.D. and Chuck Dean

Book for returning veterans and families describes effects of post traumatic stress disorder (PTSD), concussion and stress among service members coming home from wars in Iraq and Afghanistan. 

By Marilyn Lash, M.S.W.

 Lash and Associates Publishing/Training Inc.

Risks of injury, PTSD and concussion among troops and veterans

 The wars in Iraq and Afghanistan have involved the greatest numbers of American armed forces fighting in foreign lands since the end of the Vietnam War. But the men and women who have been deployed for Operation Iraqi Freedom and Operation Enduring Freedom (Afghanistan) differ markedly from the troops fighting in any other war in US history. The Department of Defense reported close to half – about 45% – of them are Reservists and members of the National Guard. More than 40% of National Guard members have been sent there more than once. And it’s not just the male Reservists who have been called up. Over 14% are women, many who have young children at home (Driscoll, 2008).

Time to move!

These men and women have been in active service for periods often as long as 2 years or more. This has resulted in enormous disruptions for their families and communities. For many, it means leaving their job, putting educational plans on hold, and taking a drop in income. But the biggest changes are those faced by their families as siblings, parents, sons and daughters leave for combat.

The changes and stresses are enormous for the family members who are left behind – whether it is aging parents worried about their son or daughter’s safety or spouses now raising children and managing a household as single parents. All worry about the safety of their loved one. There is always the fear of injury or death– with daily reminders in the newspaper and news programs of just how dangerous it is over there. Not until they return home can their loved ones finally experience the relief of knowing they are safe.

Coming home can boomerang 

Because our Reservists have such extended tours of duty, many are exposed to multiple explosive blasts. Each blast carries the risk of having a concussion or mild brain injury. Under the intense pressures of combat, symptoms may not be recognized. However, cognitive changes may be more evident months later when they interfere with returning to work, resuming studies, and living with family. Mild traumatic brain injury has been found to be strongly associated with PTSD and physical health problems three to four months after service members returned home (Driscoll, 2008).

Local providers need new expertise

The Veterans Administration has implemented a national system for TBI screening and referral. However, as National Guard members and Reservists return home and come back to their local communities, they are likely to be seeking care in many different settings, some within the VA and others in the civilian sector. This means that community providers, including primary care physicians, counselors, clergy, and emergency departments are now on the front lines for identifying the effects of PTSD and mild brain injuries. It becomes imperative for the private health sector to become educated and familiar with these conditions in order to provide the necessary care, treatment and support (Driscoll, 2008).

Reference

Driscoll, J. 2008. Traumatic Brain Injury among “Citizen Soldiers”. Brain Injury/Professional 5(2): 18-21.

Recommended reading

This Fact Sheet is based on the special issue of Hidden Issues in Brain Injury of the Brain Injury/Professional (vol. 5, issue 2), 2008. Back issues are available by calling the publisher at  (800) 321-7037 .

Brain Injury/Professional is the largest professional circulation publication on the subject of brain injury and is the official publication of the North American Brain Injury Society (NABIS). Brain Injury/Professional is published jointly by NABIS and HDI Publishers. Members of NABIS receive a subscription as a benefit of NABIS. Visit www.nabis.org to become a member.

Additional resources on military are available from the Military/Veterans page at Lash and Associates Publishing/Training, Inc. including:

Understanding the Effects of Concussion, Blast and Brain Injuries

Blast injury, PTSD and brain injury guide for families and caregivers on the consequences of concussion in veterans. Used by many VA Hospitals and Army Medical Facilities.

Veterans Tool Kit 

Brain Injury Concussion Veterans Tool Kit for families and clinicians treating veterans. Includes books and manuals with practical information on treatment, rehabilitation and recovery after traumatic brain injury,concussion and PTSD.