Shock to the System

Soldiers who manage to walk away from explosions in Iraq may actually be suffering terrible—yet invisible—brain trauma. Could blast waves be fueling a new breed of injury?

By Eric Hagerman Posted 08.22.2008 at 9:54 am 8 Comments

HEAD-ON: The “shock tube” at Johns Hopkins University simulates blasts waves. In one experiment, scientists fire jets of air at a dummy head. Sensors inside measure the force of the blow. John B. Carnett

What nobody knows is what all these forces do to the brain. A blow to the head from a blunt object can cause a concussion, certainly, but how is it that soldiers are coming home with brain injuries without ever having been hit in the head? A military task force acknowledged in April that the rate of traumatic brain injury “is thought to be significantly higher than in any previous war.” In a report called “Invisible Wounds,” the public-policy think tank the Rand Corporation estimated that as many as 19.5 percent of soldiers—320,000 of the 1.64 million soldiers sent to Iraq and Afghanistan—may suffer from traumatic brain injury. It’s impossible to say how many of them have actual damage, though, because a diagnosis would require more tests, and 57 percent of the people in this group report that they have never undergone medical evaluations for head trauma. “We have one in five soldiers with a probable traumatic brain injury, and we just don’t know what that means in terms of future impairments and needs,” says Terri Tanielian, a Rand senior research analyst who edited the report. “The unknown really is the public-health concern.”

Part of the difficulty facing researchers and doctors is that the military’s concusssion-screening questionnaire asks soldiers to report events they may well have forgotten. Even in the hospital, symptoms of mild traumatic brain injuries are easy to miss because the subtle bruising or swelling rarely shows up on scans, and in many cases there may be no gaping wound to call attention to the problem in the first place. So doctors are left to work backward from symptoms: A soldier with a traumatic brain injury might complain of headaches, sleep disturbances, and sensitivity to light and noise, and neuropsychological testing may reveal cognitive sluggishness. Not surprisingly, these changes can make people irritable and transform their overall personality, jeopardizing their relationships and jobs. “They come home a different person,” says Hussey’s doctor, Steven Scott, who runs the brain-injury clinic at the James A. Haley Veterans Hospital in Tampa, Florida. “Almost everyone is willing to accept that there’s an emotional component, but they don’t feel that’s the only explanation. When you look at the power of these blasts, it makes so much sense.”

Confounding the diagnosis in blast victims is the overlap with PTSD. It’s possible that a violent explosion could cause both physical and psychological trauma. “We do the best we can to try to sort them out,” says neurologist Gary Abrams, who heads the rehabilitation center at the San Francisco Veterans Administration Hospital, “but it’s very difficult.”

As a result, soldiers with undocumented brain injuries may never get the right medical benefits and care. The military is wrestling with how to determine whether soldiers who seem fine after surviving an explosion should return to combat. After all, if every IED victim were evacuated, the loss would gut the military’s fighting capability. And from a tactical standpoint, the military needs to know what’s causing these injuries before it can design better gear to protect soldiers.

Aftershocks

Specialist Hussey keeps a hectic schedule these days. He and his wife are separated, and he takes care of his two teenage sons in a small apartment close to Fort Jackson. Aside from his duties as a single father, his weekly roster of appointments includes 15 to 20 clinical visits—to a neurologist, psychologist, psychiatrist, occupational therapist, physical therapist and pain specialist, as well as PTSD and Alcoholics Anonymous group meetings. The passenger seat in his car used to be littered with appointment slips before the Army issued him a PDA to keep track of it all, as it has started doing with brain-trauma patients.

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8 Comments

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lpbman

08/24/08 at 12:02 pm

Are you sure that Rand survey was talking about all deployed troops? That number seems high, and I wonder if they weren't referring to front line soldiers.
Anyone have a direct reference?

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JDiez

08/25/08 at 6:56 am

Perhaps would be good to try a Faraday cage kind of system integrated inside a helmet.
That's a way to protect from EMP

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Bentfish

08/25/08 at 10:08 pm

The first commentor may have been dropped on his head as a child. I suffered a TBI in 1991 and spent the next fifteen years recovering from it. When I awoke from an induced coma, my IQ had been cut in half. I was Forrest Gump without the math. It took 15 years to get it back to 124, still a 20% loss of cognitive function. And will they even have that much to spare? I still suffer the sequeli today.
Is the army willing to put the monies needed for thousands to recover from this type of long term disability. Or are we headed to a situation like the post vietnam era. With untreated soliers living under bridges and self medicating with drugs and alcohol.

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Wake2sa

09/06/08 at 5:30 pm

The brief but extreme blast forces on the thorax and abdomen force venous and arterial blood as well as cerebral spinal fluid retrograde into the cranium like multiple caliber shotgun blasts through foramina or openings at the base of the skull. The brain, having no place to go, receives multiple traumatic squeezing forces due to the different diameters of these openings. Neuroimaging should reveal evidence of injury in keeping with these anatomic alterations along the inferior surfaces of the brain and along the course of major vascular supply and CSF spaces. I propose preventing or reducing these blast forces by wearing a blast resistant, hard shell of strong carbon composite material over the entire chest and abdomen minimizing these pressures to the brain and thereby preventing these devastating injuries.

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wafflehead

10/06/08 at 3:51 pm

i'm not sure, what is needed, but the one thing thats certain is that a much better system is needed to protect our troops!

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bpursun

10/22/08 at 11:31 am

I FOUND THAT THIS ARTICLE IS CORRECT IN THE SYPTOMS, BUT WRONG IN THE REASON. THIS IS BATTLE FATIGUE, AND THE SAME AS THE VIETNAM VETERANS SUFFERED.
THE EARLY ARTICLE IN THE SAME ISSUE IS VERY ACCURATE.
LONG PERIONS OF STRESS = PLUS A MAJOR SHOCK OF ANY KIND IS THE ISSUE.
IT PRODUCES CORTISON WHICH DAMAGES THE HIPPOCAMPUR AND THE ENTIRE PITUATARY GLAND. THIS AFFECT THE ENTIRE BODAY. THE DIAGRAM AT THE END IS EXTREMELY CORRECT IN THE RUSULT. RESEACH IT YOURSELF AND FIND OUT.

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Mike Cook

from Kent, WA

11/20/08 at 5:37 am

Way back in the 1950's and 1960's there was a German guy who had survived a grenade explosion next to his body in W.W.II and developed a theory about how a properly positioned human body can survive an explosion if the shrapnel doesn't kill the subject. The ex-soldier developed a carnival routine which I witnessed during a demolition derby half-time. He built a coffin out of cheap plywood and about a foot from the head of it was placed a stick of 50% dynamite. Then he would lay down in the coffin without even a helmet and detonate the explosive, spectacularly demolishing the coffin and leaving himself unharmed.

As an entertainment routine this act was spectacular (I believe I read about it in Popular Science before actually seeing it) but took place so quickly that the guy had to do a lot of talking and build-up in order to hold 15 minutes of the audience's attention until a climax that would only take a micro-second.

In his heavily accented English the guy admitted that he had gone deaf from doing this stunt. He also said that the closest he had come to being really hurt was when he performed the routine out on the end of a pier at a marina show in Florida. The plan was that the blast would drop him spectacularly into the water. It worked as planned but what he didn't know is that explosions create a great amount of static electricity. As soon as he contacted the water he suffered serious burns over a good part of his body.

I can't remember his name other than that it was German.

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Neuuubeh

01/09/09 at 11:26 am

So, shockwaves from explosions can damage the human body... How is this a surprise really? Receiving an abrupt blow to the head can lead to coma, but apprarently having a grenade explode a couple of meters from the head cannot be dangerous??

This kind of reminds me of the first experiments with atomic weaponry, noone thought the radiation could be "bad" - we all know how that turned out.