For Iraq Veterans, Headaches Continue After Traumatic Brain Injury

/PRNewswire-USNewswire/ -- Many soldiers who experienced mild head trauma or a blast exposure while serving in Iraq or Afghanistan are returning to the United States with headaches, according to a study released today that will be presented at the American Academy of Neurology's 61st Annual Meeting in Seattle, April 25 to May 2, 2009.

The study, conducted at Fort Lewis, WA, involved 978 U.S. Army soldiers returning from Iraq or Afghanistan in 2008. All had experienced a concussion, head injury or blast exposure while deployed.

Nearly 98 percent of the soldiers reported having headaches during the last three months of their deployment. The headaches started within one week of the traumatic brain injury for 37 percent of the soldiers, and within one to four weeks for 20 percent. Among the soldiers whose headaches started within a week of the injury, 60 percent had migraine-like headaches and 40 percent had headaches that interfered with their ability to do their daily activities. Thirty percent had headaches for 15 or more days each month.

"Mild traumatic brain injury is occurring in 15 to 25 percent of soldiers deployed to Iraq or Afghanistan," said study author Brett J. Theeler, MD, of Madigan Army Medical Center in Tacoma, WA, and a member of the American Academy of Neurology. "The associated headaches can be a source of impaired occupational functioning. These findings should alert health care providers, especially those affiliated with the military or veteran health care systems, to the need to identify and properly treat headaches among soldiers."

The study was supported by the Uniformed Services University of the Health Sciences through a grant from the Congressionally Directed Medical Research Program.

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Team Teaches CPR to Afghan Medical Providers

Six Afghan medical providers learned basic lifesaving skills at a Panjshir Provincial Reconstruction Team cardiopulmonary resuscitation course held at the Rokha Clinic on June 18.

Air Force Staff Sgt. Janine Duschka, a PRT medical technician deployed from Andrews Air Force Base, Md., taught the course.

"It is important to teach the local medical providers, because it gives them another tool to save lives," Duschka said. "The tools they take home with them today are not ones they have to carry in their medical bags, and they're not something that they have to spend their money on. They're taking home knowledge that they can share with the rest of their staffs."

The medical providers were from six different clinics and four of the province's seven districts.

"This training is crucial, because most of the province's health care providers are in rural locations, so they need to be able to do [CPR] in order to get their critical patients to the hospital or to a better clinic," said Dr. Shirdell, Panjshir health and medical services officer.

The CPR class is the one-day American Heart Association course for health care providers authorized by the Military Training Network in Bethesda, Md. It covers not only CPR for patients of all ages, but also how to handle someone who is choking and the proper use of an automated external defibrillator unit.

The course also focuses on how to assess a patient to see if CPR is even necessary, and Duschka said she sees patient assessment as one of the main tools taught by the course.

"Now the medical providers know how to assess the signs the patient is giving instead of just reacting to a patient when they arrive," Duschka said. "Many of the Afghan medical providers I've dealt with in the past would have immediately started to give artificial breathing or CPR just because a patient's eyes were closed or they were unconscious, even if the patients were breathing normally already."

While some of the medical providers had learned prior forms of resuscitation, this course was new to most of them.

"They didn't have a preconceived notion of what CPR should be, since they've never taken any of the older CPR courses, so it was actually easier for me to teach them than it is teaching American students," Duschka said. "These providers all know how important this training is, and they all came ready to learn."

This is the first class out of a 15-class schedule, and I think it went very well and we all learned something from the class, Duschka said.

While Duschka taught her students the requirements from the course, they taught her some creative ways they've come up with to handle some of the trickier everyday medical situations.

For example, if a pregnant woman were choking, the providers said, they'd use a head-scarf to wrap around the woman if they couldn't reach their arms around her. Their solution uses an item that every Afghan woman keeps with her.

"Even though we're taught to use everything and anything that you have available to save the patient, using the scarf is an ingenious option that I never would have considered," Duschka said. "Although using the scarf is not a treatment of choice, the solution shows the providers clearly think outside of the box to help their patients in any way they can."

After spending the day teaching and learning from the local providers, Duschka was comfortable they would be able to provide better care to anyone who came into their clinics.

"If I came into their clinics, I know they could assess me, understand what was happening and treat me properly," she said. "Hopefully they won't ever have to use this course, but I'm happy to have been able to give the extra knowledge."

Shirdell agreed with Duschka.

"Whether they need to use [CPR] or not, they are learning that they always need to be in touch with the patient, and it is important to know what to do with a patient in any emergency situation," Shirdell said.

The PRT's CPR training program will continue throughout the year, and Duschka said she hopes to get out to different clinics in each of the province's seven districts.

Author Air Force Capt. Jillian Torango serves with the Panjshir Provincial Reconstruction Team Public Affairs Office

Army Aims to Better Identify Soldiers with Brain Injuries

By C. Todd Lopez
Special to American Forces Press Service

An Army report released yesterday outlines how the service can better identify and help soldiers who have suffered traumatic brain injuries.

The report contains some 47 recommendations to help the Army better prevent, screen, diagnose, treat and research traumatic brain injury, said Brig. Gen. Donald Bradshaw, who led the task force charged with investigating TBI. Bradshaw is commander of Southeast Regional Medical Command and Eisenhower Regional Medical Center, at Fort Gordon, Ga.

"Our report indicates that, like our civilian counterparts, the Army has done well in the identifying and treatment of severe or penetrating traumatic brain injury, but is challenged to understand, diagnose and treat personnel who have suffered short-term or persistent symptoms of mild TBI," he said. "The task force identified opportunities for improvement as well as best-practice guidelines."

The general said 80 percent of those who suffer from mild TBI, commonly known as a concussion, recover completely. Some 10 to 20 percent of soldiers and Marines returning from Iraq and Afghanistan with experience in combat may have suffered symptoms consistent with mild TBI.

Today, eight of the recommendations made by the task force have already been implemented, said Col. Judith Ruiz, deputy director for rehabilitation and reintegration with the Office of the Surgeon General.

"We have made significant progress to take care of soldiers and to standardize practices across the Army medical department," she said.

Some of the recommendations that have already been implemented include:

-- Working with interagency and civilian groups to better define TBI;

-- Implementing in-theater TBI screening and documentation for all soldiers exposed to brain injury-inducing trauma;

-- Adding TBI-specific questions to deployment-related health assessments;

-- Developing a proposal on the appropriate functions of a "TBI center of excellence";

-- Proposing the Defense and Veterans Brain Injury Center as the core of the new center of excellence;

-- Optimizing the positioning of clinical, educational and research activities;

-- Centralizing the evaluation of the scientific merit, clinical utility, and priority of new treatment strategies, devices or interventions; and

-- Adapting the Military Acute Concussion Evaluation overprint as an approved Department of the Army form to document mild TBI closest to the point of injury.

Ruiz said 31 additional recommendations are in progress, four are planned, and four are in the process of being transferred to other agencies.

For soldiers in theater, the most common cause of brain injury is a blast, such as from an improvised explosive device. But sometimes such blasts do not cause visible external injuries.

"Brain injury does not have to have outside symptoms, such as bleeding," Bradshaw said. "It may, but doesn't have to. That is one of the compounding things; folks may look totally normal, but be dazed."

Because some victims of IEDs or other blasts do not have external injures, they may feel they have not been injured at all -- even if they did sustain a mild TBI.

"It's hard to identify TBI when soldiers don't come forward and don't identify," Bradshaw said. "Some of the actions that have been taken (include) a very big ongoing education process for leaders, soldiers and family members."

The Army launched the post-traumatic stress disorder/mild traumatic brain injury chain teaching program in 2007 to help soldiers better identify signs and symptoms of these conditions and to reinforce the collective responsibility to take care of each other.

The Army is also working to educate the civilian medical community about mild TBI so that soldiers in the reserve components, who may not have full-time access to military medical care, also can be identified, said Col. (Dr.) Jonathan Jaffin, deputy commander of the U.S. Army Medical Research and Material Command.

"One of the things we are concerned with and ... one of the points behind the whole chain teaching was trying to get the message out to the country, not just the active-duty force, Guard and reserve," he said. "(We wanted) the country, including providers throughout the country, to be aware of mild TBI and concussions and the long-term symptoms that some people may be having."

Bradshaw said Army leaders at all levels are committed to the good health and well-being of all soldiers and are proactively addressing the issue of TBI. "Continued research in this area can only help us more clearly understand the medical impacts of the war and the best ways to prevent, recognize and treat soldiers with TBI," he said.

(C. Todd Lopez works for the Army News Service.)