Blast Injuries and Concussions in Veterans

Returning Veterans with Concussions

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.


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.

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