The Army's Approach to Brain Injury Awareness

Lt. Gen. Eric B. Schoomaker, U.S. Army Surgeon General

March 12, 2010 - March is Brain Injury Awareness Month across the land, but many in the Army -- line and medical leaders, Army trainers at our Combined Training Centers (National Training Center in Ft. Irwin, Calif., and Joint Readiness Training Center in Ft. Polk, La.), first line medics, and our deploying combat arms soldiers -- have already been receiving a unique education and training on traumatic brain injury (TBI) delivered personally by the vice chief of staff himself, Gen. Peter Chiarelli. Senior Army leaders -- especially my colleagues and superiors who are not medical professionals -- recognize that TBI is a serious concern; we have dedicated substantial effort and resources to prevent, diagnose, treat and better understand promising treatments for mild, moderate, and severe TBI.

The more severe forms of head and brain injury are not subtle: They involve a major skull or facial fracture or a penetrating wound such as might occur in a sniper attack, major explosion or severe motor vehicle accidents. Victims are often rendered comatose and their wounds are obvious. The recognition of the wound is prompt and treatment is swift. Far more common, however, and receiving renewed and focused attention by the VCSA and all leaders are mild TBI or what we all call "concussions." Concussion and mild TBI are one in the same; we prefer "concussion."

While the incidence of new cases of moderate and severe TBIs is not growing, that of concussions is. Some of this increase may be because we are more apt to recognize and treat it. This is a good thing since the vast majority of concussions will heal without long-term lingering problems such as problems with memory, word-finding and other speech and language problems, headaches and such. I myself suffered a concussion on a rugby pitch 20 years ago in a collision with another player which broke my cheekbone and knocked me out for 20 minutes, leaving me with no memory of the entire game ("retrograde amnesia") and the hours before it. I rested for a number of days and recovered uneventfully.

But some of the increase undoubtedly derives from just the opposite: the rising number of soldiers and their fellow Warriors who are subjected to multiple sequential concussions. These are not promptly diagnosed and are not treated appropriately at the time of the incident -- IED blast, motor vehicle accident, sports injury or other event. The consequence of these repeated injuries during the period in which the brain is recovering may result in far more serious long-term effects.

It is this new effort to more promptly identify concussed warriors as close to the event which results in the injury which is the centerpiece of the new "Educate-Train-Treat-Track" program being led by the VCSA. In my next blog, I'll share with you who is receiving the first round of education and training and how this is intended to reduce the effects on concussion on the battlefield and back in home station.