Army Continues to Treat Blast-Related Injuries

By John J. Kruzel
American Forces Press Service

Feb. 7, 2008 - The Army is aggressively diagnosing and treating soldiers who suffer concussive injuries and stress related to blast attacks, the Army's surgeon general said today. Lt. Gen. (Dr.) Eric B. Schoomaker, Army surgeon general and commander of U.S. Army Medical Command, told reporters during a media roundtable at the Pentagon today that issues stemming from such combat conditions are a "great concern" to soldiers, their families and the American public.

"We know the importance of prevention of these injuries and illnesses; we know the importance of timely diagnosis and treatment of both concussive and post-traumatic stress symptoms," Schoomaker said. "And we are aggressively executing programs that are designed to educate, to prevent, to screen and to provide the appropriate care in a timely fashion for all of these deployment-related stresses and injuries."

Concussive injuries and their psychological responses are "not new concepts to us," the general said. He noted that concussions occur domestically -- on America's highways and sports fields -- as often as they do in combat, and that referring to them as the war's "signature injury" is a mischaracterization.

Schoomaker said he doesn't believe the war on terror has produced any one signature injury. But he believes there is a signature weapon used by insurgents: a blast.

"It's being used very effectively in combat," he said. "It blinds our soldiers in some cases if they're unprotected. It deafens them. If it defeats our protective equipment, it may cause a mild concussive injury all the way to a very severe penetrating head injury."

The general said military health care professionals must identify and treat blast-related injuries as soon as possible after the event.

"Doing an effective screening as close as possible to the actual event and then making a decision whether that soldier should take a knee and step out of the battle so that they can recover ... is our most important goal," he said

Schoomaker said the Army created initiatives to increase the rapidity and efficiency of treatment, including arming medics to allow them to more safely treat wounded troops in combat zones, providing servicemembers with improved first aid kits, and training troops in medical techniques. In addition, in 2007 the Army instituted an 800,000-strong chain-teaching initiative -- from the most seasoned commander down to the most junior soldiers -- on concussive injuries and post-traumatic stress.

Army health officials are looking into the role context plays in a concussive injury and its aftermath, Schoomaker said, which may be a more significant factor than originally thought. To illustrate the importance of context, the general made an analogy to a quarterback who is hit hard in the course of a football game. Regaining consciousness while surrounded by thousands of sympathetic fans is a vastly different context from awakening in a combat zone, surrounded by the wounded bodies of your battle buddies, he said.

While screenings performed immediately after returning from deployment might be successful in identifying physical symptoms, the process might allow gaps in detecting latent symptoms related to context. Because certain emotional symptoms related to concussive injuries or combat stress emerge later than their physical counterparts, Schoomaker said, he advocates an additional screening three to six months after deployments. Identifying the root of emotional symptoms may help affected servicemembers avoid family, social, alcohol or other problems resulting from a lack of proper diagnosis and treatment.

Army Col. (Dr.) Loree Sutton said 10 to 15 percent of those with concussive injuries display "persistent symptoms," generally cases when the physical injury is complicated by psychological issues. Sutton is chief of the Defense Department's newly created Defense Center of Excellence for Psychological Health and Traumatic Brain Injury. The center reflects the department's effort to step up the quality of care for wounded warriors and their families.

"We need to ensure that we ... put out the message in general that concussions heal in the vast majority of cases, and that's a good-news story," she said. "In that small minority of cases where symptoms persist, we need to take a comprehensive, holistic view."

Schoomaker emphasized the military health community's dedication to caring for injured servicemembers.

"America can truly be assured that we are not going to rest until all our soldiers who have been wounded or are injured or are ill in the service to the nation are cared for both competently and compassionately," he said. "They'll receive the best support from the United States Army, the Department of Defense and the Department of Veterans Affairs."