Mary Garrigan, Journal staff | Posted: Thursday, May 17, 2007 11:00 pm
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Frontline combat
troops in the Iraq war have at least a one in five chance of coming
home with a brain injury, according to Chris Elia, a Veterans
Affairs psychologist who spoke Friday about traumatic brain
injuries in veterans at the second annual Black Hills Brain Injury
Conference in Rapid City.
"And I suspect it's
a much higher chance than that," Elia said, presenting an array of
statistics about what has become the "signature wound" of the wars
in Iraq and Afghanistan.
Of the 23,000 U.S.
soldiers, marines and other military personnel who have been
wounded in Iraq and Afghanistan since 2002, more than 6,500 have
been diagnosed with traumatic brain injury, according to military
figures. Elia said those numbers are probably low, given what
today's war is still teaching medical experts about blast
injuries.
There is little or
no good historical information about the incidence or survival
rates of traumatic brain injury from past wars, he said. But the
current war is bringing brain injury "out of the closet" in much
the same way that the Vietnam War brought post-traumatic stress
disorder to the public's attention.
"I think that's a
good thing," Elia said, while acknowledging that the topic of
traumatic brain injury is a "critically-charged one" in the ongoing
political debate about the war.
Brain injuries are
nothing new to warfare, he said. "I think it was always the
signature wound of war; it's just that people didn't survive them,"
he said.
Mortality rates
from combat injuries have fallen from 30 percent in World War II to
10 percent in the Iraq and Afghanistan wars. Vietnam had a 24
percent injury mortality rate, and Desert Storm's rate was 20
percent, Elia said.
That huge drop in
mortality rates is due to the speed with which specialized care is
now available, he said. Craniotomies can be performed just one step
off the battlefield today, and medical care that took two weeks to
deliver in the Vietnam era is now available within four days of
injury, Elia said.
He told the story
of one Minnesota National Guardsman who is now dealing with a
traumatic brain injury incurred in Afghanistan in 2003, only
because he was fortunate enough to survive the other "horrific
injuries that would certainly have killed him a few decades
ago."
And while explosive
blasts are not a new way to fight wars, they have become more
specifically targeted in today's wars. Better body armor and
helmets are helping those targets survive by protecting heads and
major body organs - but at a cost, he said.
"The downside to
Kevlar and improved body armor - and that may be an odd way to put
it - is that the amputation rates are double in this war," Elia
said.
The biomechanics of
any blast injury are complex, in part, because they involve so many
different kinds of injury. There's the primary concussive injury
caused when air pressure and temperature inside the brain rise, but
also penetration and impact injuries. Still, 47 percent of all
combat blasts affect the brain, even when there is no apparent
injury to the head, Elia said.
One study of 433
traumatic brain-injury patients at Walter Reed Medical Center found
that 90 percent of those brain injuries were closed-head injuries,
meaning there was no obvious entry wound.
That fact is why,
since March of this year, all VA technicians get mandated training
to identify TBI, Elia said.
Veterans who
deployed to Iraq and Afghanistan now get routine brain-injury
screening by the VA. For the first time, the medical histories of
veterans will ask if they incurred exposure to blasts of any kind
and if they have experienced any of a list of symptoms related to
TBI and PTSD.
The two injuries
are linked, Elia said. Slowly, veterans from the Middle East
theater of operations are slowly beginning to show up in the PTSD
support group offered specifically for them at the VA clinic in
Rapid City.
To exchange stories
and information about brain injury among veterans, go to
www.avbi.org
Contact Mary
Garrigan at 394-8410 or
mary.garrigan@rapidcityjournal.com
