Brain Injuries High Among Iraq Casualties

By Spc. Chuck Wagner

U.S. casualties in Iraq may be suffering a greater share of brain injuries than in previous wars, causing concern among military doctors.

Doctors with the Defense and Veterans Brain Injury Center at Walter Reed Army Medical Center say early casualty assessments suggest service members are returning with a wide range of brain injuries - from mild concussions to coma or death - in larger percentages than the military's rule of thumb.

This suspected rise in an injury notoriously debilitating to victims and hard for doctors to diagnose may result from the terrorists' explosive arsenal and vulnerabilities in current U.S. combat gear, according to experts.

"It's always been well known there are going to be brain injuries in combat," said Dr. Louis French, a neuropsychologist and assistant director for clinical services at the brain center. "About 20 percent is usually what's talked about. So far, what we've seen suggests a higher percentage."

Among 105 casualties assessed between June and October, doctors discovered about two-thirds, or 67 percent, to have brain injuries, according to Dr. Laurie Ryan, another neuropsychologist and the assistant director for research.

The center is pursuing several studies to statistically verify the trend.

The cause for the dramatic increase seems to be the changed nature of warfare in Iraq. The terrorists' weapons of choice are high explosives. Land mines, rocket propelled grenades and improvised bombs allow terrorists to skirt direct engagement with better trained and equipped soldiers, and can still inflict damage to soldiers whose torso, or in military jargon their "center mass", is protected against small arms ballistics.

"There's not as many gunshot wounds," French bluntly noted.

Ironically, a well-protected body has forced the enemy to attack the brain, the only organ still vulnerable to deadly attack.

Another leading cause of head injuries is vehicle accidents, said Ryan, followed by falls.

Although soldiers are wearing head protection, the Kevlar helmet may not be serving soldiers as a solid defense against modern warfare's growing threat - concussive impact.

"It's like a pan on your head, held on by shoestring webbing," said Sgt. Tyler Hall of the 14th Combat Engineers, Fort Lewis Washington. "The Kevlar is a crude system. When you take a hit, it rings your head like a bell."

"It's not designed to absorb impact," French concurred.

Hall has been treated in the center since August, when a convoy traveling near Tikrit came under attack. Terrorists rigged a 155 mm howitzer shell to detonate in the sand as the convoy drove past. The explosion blew through the vehicle's bed and tossed Hall. He landed face down. From the moment he was put on a Blackhawk helicopter until he awoke at Walter Reed a month later, Hall was in a coma caused by the blunt force against his head, despite wearing a Kevlar. He's undergone several surgeries to reconstruct the bones in his face and drain fluid from his brain.

Doctors are treating Hall for several injuries, but it's the head injury that repeatedly threatened to rob Hall of his life, and later the ability to appreciate that he still had a life.

"Day to day I'm getting better. A fog is finally off my eyes. It's frustrating, very frustrating. It's like fighting something you don't see, no one sees, but you can feel it," said Hall, who's improved under intense care at the center but still suffers headaches, nausea, and memory loss. "I still misplace things. I just want to be able to ride in a car again without getting sick."

French and Ryan said brain injuries add a new element of difficulty to casualty assessment, because the injuries are challenging to diagnose and difficult to differentiate from symptoms of other injuries, for instance the symptoms of psychological stress.

"A blow to the head is known to cause depression. Anyone who is returning from a situation in which they are being shot at is likely to experience emotional trauma that can cause depression. It's hard to draw a line between them," said French. "They share symptoms."

He admits brain injuries may be neglected, or even pushed aside as merely psychological.

"They are suffering just as much, but may not get the same support as someone who has an observable injury like a bullet wound or a broken leg," said French.

Brain injuries can exert themselves in physical, cognitive or emotional symptoms, and left untreated they can pose significant hurdles to recovery.

The center is seeking out possible brain injury casualties instead of waiting for referred patients. Doctors screen each new casualty list in search of those likely to have experienced concussive impact, like those in explosions, vehicle accidents or falls. Doctors arrange for personal interviews with high-risk service members. They've screened over 100 patients so far, and continue the effort with Walter Reed's approximately 10 daily arrivals, said Ryan.

The brain center on Walter Reed is the headquarters for eight different centers, including four veterans' affairs, three military and a civilian site. The center is congressionally funded. It works hand in hand, but independently with other medical facilities on Walter Reed.

The center's doctors also are involved in analyzing the newly developed Modular Integrated Communication Helmet (MICH) for its protection against impact-related injuries, said Ryan.

The MICH is currently fielded with Rangers, Special Forces, Navy SEALS, Air Force Special Operations, the Marine reconnaissance community, the FBI's Hostage Response Team, and a brigade at the 82nd Airborne Division, according to a MICH project officer.

The padded MICH is the only ballistic helmet used by Special Operations Command also authorized for use with motorcycles or other all-terrain vehicles, which the project says attests to improved impact protection. Lab testing showed a 40 percent improvement in impact protection over the Kevlar.

The jury is still out on whether the MICH can protect against the causes of brain injuries faced in Iraq, but there's at least one soldier voting in favor of dampening the blows landing on our troops' heads.

"The Kevlar physically moves and bounces on your head. It's heavy and you hear soldiers complaining about headaches a lot," said Hall, running his hand along the back of his head, still laced with metal sutures. "I'd like to see the Army find something better."