Military Leads in Brain Injury Care, Specialists Say

By Lisa Daniel

American Forces Press Service

WASHINGTON  – Army, Navy, Air Force and Marine Corps medical specialists are working closely together and with civilian experts to develop the best prevention, diagnosis and treatment practices for traumatic brain injuries, service representatives said yesterday.

“[The Defense Department] is in the lead in making sure we learn all we can about the brain and brain injuries,” Maj. Sarah Goldman, director of the Army Medical Specialist Corps traumatic brain injury program, said during a Pentagon Channel panel discussion about military brain injury programs.

Goldman, a research specialist with a doctorate in kinesiology in the Army surgeon general’s office, was joined by her counterparts representing the other services’ traumatic brain injury programs: Cmdr. (Dr.) Jack Tsao, a neurologist at the Navy Bureau of Medicine and Surgery; Maj. (Dr.) Laura Baugh, a neurologist with the Air Force Medical Support Agency; and Navy Capt. (Dr.) David Tarantino, a family practice physician assigned to Marine Corps headquarters.

“We have different lenses we bring to the table, and it’s that diversity that gives us strength,” Goldman said.

The team also works with brain injury experts in academia and civilian medicine to share knowledge and “increase the comfort level” of medical professionals in treating brain injuries, Goldman said.

“We want to make sure that with the innovations and practices we identify, we can move forward together,” she said.

Service members are more susceptible to brain injuries than civilians, although an estimated 84 percent of brain injuries to troops occur not on deployment, but back home, the panelists said. And most are preventable, they added.

Training injuries, sports injuries and car wrecks cause most brain injuries, Tarantino said. “A lot of TBI is preventable,” he said, if people wear protective gear such as helmets and seat belts.

The quality of protective gear has come a long way, Tarantino said, “but it only works if you wear it.”

With combat-related brain injuries, the services have learned much from 10 years of war, the panelists said. Identification of brain injuries on the battlefield has been “firmly codified,” and rest following a brain injury now is mandated, Tsao said.

“We think we have the most effective combat treatment centers in the history of warfare,” Tarantino said of the Navy and Marine Corps program. “It starts with self care and buddy care,” he explained.

After a head injury, a service member assesses himself -- or his buddy assesses him -- for symptoms of concussion, such as blacking out or dizziness. The service member then is seen by a Navy corpsman, and if identified as having a concussion or worse brain injury, is sent to triage for care, and then may be evacuated for more intensive care, Tarrantino said. Military medical facilities for treating head injuries are located throughout Afghanistan, he noted.

For rehabilitation, the Marine Corps’ Concussion Restoration Care Center -- an interdisciplinary facility including family, sports medicine and other specialists -- has treated hundreds of concussions, with a 98 percent rate of full recovery, he said.

The military’s efforts in traumatic brain injuries have benefited from increased awareness about brain injuries inside the Defense Department and in Congress, as well as from attention the issue has been receiving in the National Football League and the National Hockey League, Tsao said. “All of those things have made our jobs easier,” he added.

In fact, much of the latest discoveries into brain injuries have happened in the sports world, and the Army and Marine Corps are partnering with the NFL to share information, Goldman said.

The services continue to work against a stigma some service members attach to seeking help, and a new Army policy takes that decision out of soldiers’ hands, Goldman said. Anyone involved in a blast or other event causing head trauma must be taken out of the fight and examined, he added.

Other services are following the same mandate, Baugh noted. Service members now recognize the events that cause brain injuries and the symptoms that indicate those injuries, and they know the requirement that they get examined, she said.

Air Force medical officials try to keep TBI patients in the care of their primary physicians, at home and with their families, Baugh said. The Air Force’s Echo pilot program uses technology to bring the TBI team’s expertise to the service members and their providers.

Tsao said the Navy is working to prevent brain injuries, and to educate sailors and Marines about symptoms, treatment and effects. The most important treatment of concussions is rest, he said, and education is critical.

“Telling patients what to expect makes a world of difference,” he said.

Symptoms of TBI include temporary loss of consciousness, headache, dizziness, and, in severe injuries, long-term memory and concentration problems, panelists said.

Most people with mild brain injuries recover within days or weeks, and 85 percent recover within three months, they said.