American Contractors in Iraq
Traumatic Brain Injury
The symptoms of mild traumatic brain injury and post traumatic
stress disorder can be identical and you may have both.
Auditory system injuries and concussions are easily overlooked.
Traumatic Brain Injury
The symptoms of mild traumatic brain injury and post traumatic
stress disorder can be identical and you may have both.
Auditory system injuries and concussions are easily overlooked.
Explosions and Blast Injuries
CLASSIFICATION OF EXPLOSIVES
Explosives are categorized as high-order explosives (HE) or low-order
explosives (LE).
High-order explosives produce a defining supersonic over-
pressurization shock wave. Examples of HE include TNT, C-4, Semtex,
nitroglycerin, dynamite, and ammonium nitrate fuel oil (ANFO).
Low-order explosives create a subsonic explosion and that does not
produce over-pressurization. Examples of LE include pipe bombs,
gunpowder, and most purely petroleum-based bombs such as Molotov
cocktails or aircraft improvised as guided missiles. High-order and low-
order explosives cause different injury patterns.
Explosive and incendiary (fire) bombs are further characterized based on
their source.
Manufactured implies standard military-issued, mass-produced, and
quality-tested weapons. Improvised describes weapons produced in
small quantities, or the use of a device outside its intended purpose,
such as converting a commercial aircraft into a guided missile.
Manufactured (military) explosive weapons are exclusively HE-based.
Terrorists will use whatever is available—illegally obtained manufactured
weapons or improvised explosive devices (IEDs) that may be composed
of HE, LE, or both. Manufactured and improvised bombs cause markedly
different injuries.
BLAST INJURIES
Mechanisms of Injuries
The four basic mechanisms of blast injury are termed as primary,
secondary, tertiary, and quaternary (Table 1). An example that causes
primary injury is blast wave, which refers to the intense over-
pressurization impulse created by a detonated HE. Blast injuries are
characterized by anatomic and physiologic changes that occur when the
direct or reflective over-pressurization force impacts the body's surface.
The HE blast wave (over-pressure component) should be distinguished
from blast wind (forced superheated air flow). Blast wind may be
encountered with both HE and LE.
Low-order explosives are classified differently because they lack the
defining over-pressurization wave of HEs. Low-order explosives cause
injury from ballistics (fragmentation), blast wind (not blast wave), and
thermal. There is some overlap between LE descriptive mechanisms and
HE's secondary, tertiary, and quaternary mechanisms.
Up to 10% of all blast survivors have significant eye injuries, generally
due to perforations from high-velocity projectiles. They can occur with
minimal initial discomfort, and present for care days, weeks, or months
after the event. Symptoms include eye pain or irritation, foreign body
sensation, altered vision, periorbital swelling, or contusions. Findings
can include decreased visual acuity, hyphema, globe perforation,
subconjunctival hemorrhage, foreign body, or lid lacerations. Liberal
referral for ophthalmologic screening is encouraged.
BRAIN INJURY
Primary blast waves can cause concussions or mild traumatic brain
injury (TBI) without a direct blow to the head. Consider the proximity of
the victim to the blast, particularly when the patient complains of
headache, fatigue, poor concentration, lethargy, depression, anxiety,
insomnia, or other constitutional symptoms. The symptoms of
concussion and post traumatic stress disorder can be similar.
The signs and symptoms of a TBI can be subtle. Symptoms of a TBI may
not appear until days or weeks following the injury or may even be
missed when patients appear fine, even though they may act or feel
differently (CDC, 2005b).
Diagnosing a TBI is challenging because symptoms are often common to
other medical conditions and the severity of the symptoms can change
over time. Any patient may have a TBI who has a history of head trauma
or who is suffering from confusion, disorientation, amnesia of events
around the time of injury, loss of consciousness of 30 minutes or less,
neurologic or neuropsychological problems, or who has a Glasgow
Coma Scale (GCS) score of 13 or higher. Taking a careful medical history
can be key to detecting a TBI. Any unusual or unexplained signs or
symptoms should be evaluated further (CDC, 2005b).
Auditory system injuries and concussions are easily overlooked. The
symptoms of mild traumatic brain injury and post traumatic stress
disorder can be identical.
CLASSIFICATION OF EXPLOSIVES
Explosives are categorized as high-order explosives (HE) or low-order
explosives (LE).
High-order explosives produce a defining supersonic over-
pressurization shock wave. Examples of HE include TNT, C-4, Semtex,
nitroglycerin, dynamite, and ammonium nitrate fuel oil (ANFO).
Low-order explosives create a subsonic explosion and that does not
produce over-pressurization. Examples of LE include pipe bombs,
gunpowder, and most purely petroleum-based bombs such as Molotov
cocktails or aircraft improvised as guided missiles. High-order and low-
order explosives cause different injury patterns.
Explosive and incendiary (fire) bombs are further characterized based on
their source.
Manufactured implies standard military-issued, mass-produced, and
quality-tested weapons. Improvised describes weapons produced in
small quantities, or the use of a device outside its intended purpose,
such as converting a commercial aircraft into a guided missile.
Manufactured (military) explosive weapons are exclusively HE-based.
Terrorists will use whatever is available—illegally obtained manufactured
weapons or improvised explosive devices (IEDs) that may be composed
of HE, LE, or both. Manufactured and improvised bombs cause markedly
different injuries.
BLAST INJURIES
Mechanisms of Injuries
The four basic mechanisms of blast injury are termed as primary,
secondary, tertiary, and quaternary (Table 1). An example that causes
primary injury is blast wave, which refers to the intense over-
pressurization impulse created by a detonated HE. Blast injuries are
characterized by anatomic and physiologic changes that occur when the
direct or reflective over-pressurization force impacts the body's surface.
The HE blast wave (over-pressure component) should be distinguished
from blast wind (forced superheated air flow). Blast wind may be
encountered with both HE and LE.
Low-order explosives are classified differently because they lack the
defining over-pressurization wave of HEs. Low-order explosives cause
injury from ballistics (fragmentation), blast wind (not blast wave), and
thermal. There is some overlap between LE descriptive mechanisms and
HE's secondary, tertiary, and quaternary mechanisms.
Up to 10% of all blast survivors have significant eye injuries, generally
due to perforations from high-velocity projectiles. They can occur with
minimal initial discomfort, and present for care days, weeks, or months
after the event. Symptoms include eye pain or irritation, foreign body
sensation, altered vision, periorbital swelling, or contusions. Findings
can include decreased visual acuity, hyphema, globe perforation,
subconjunctival hemorrhage, foreign body, or lid lacerations. Liberal
referral for ophthalmologic screening is encouraged.
BRAIN INJURY
Primary blast waves can cause concussions or mild traumatic brain
injury (TBI) without a direct blow to the head. Consider the proximity of
the victim to the blast, particularly when the patient complains of
headache, fatigue, poor concentration, lethargy, depression, anxiety,
insomnia, or other constitutional symptoms. The symptoms of
concussion and post traumatic stress disorder can be similar.
The signs and symptoms of a TBI can be subtle. Symptoms of a TBI may
not appear until days or weeks following the injury or may even be
missed when patients appear fine, even though they may act or feel
differently (CDC, 2005b).
Diagnosing a TBI is challenging because symptoms are often common to
other medical conditions and the severity of the symptoms can change
over time. Any patient may have a TBI who has a history of head trauma
or who is suffering from confusion, disorientation, amnesia of events
around the time of injury, loss of consciousness of 30 minutes or less,
neurologic or neuropsychological problems, or who has a Glasgow
Coma Scale (GCS) score of 13 or higher. Taking a careful medical history
can be key to detecting a TBI. Any unusual or unexplained signs or
symptoms should be evaluated further (CDC, 2005b).
Auditory system injuries and concussions are easily overlooked. The
symptoms of mild traumatic brain injury and post traumatic stress
disorder can be identical.
Attention Injured Contractors
We need your help in our efforts contact
Marcie Hascall Clark in confidence junglem@yahoo.com
Traumatic Brain Injury in the Context of War
Of the patients who required medical evacuation from theater (war zone)
to Walter Reed Army Medical Center (WRAMC), 32% had TBI.1 Of these
patients, severe and penetrating TBI comprised only 8% of the total
number of TBI patients.
Although MRI is more sensitive for the detection of diffuse axonal injury,
roughly 80% of SMs seen at the WRAMC are ineligible for MRI procedures
because of the presence of metal fragments in their bodies.
We need your help in our efforts contact
Marcie Hascall Clark in confidence junglem@yahoo.com
Traumatic Brain Injury in the Context of War
Of the patients who required medical evacuation from theater (war zone)
to Walter Reed Army Medical Center (WRAMC), 32% had TBI.1 Of these
patients, severe and penetrating TBI comprised only 8% of the total
number of TBI patients.
Although MRI is more sensitive for the detection of diffuse axonal injury,
roughly 80% of SMs seen at the WRAMC are ineligible for MRI procedures
because of the presence of metal fragments in their bodies.
If you were injured in or near a
blast do not presume that you
were screened for traumatic
brain injury
Only the most obvious cases
were acknowledged by military
medical until recently.
DoD Avoided Brain Injury
Screening
AIG and CNA WILL NOT
authorize screening for TBI
CNA just denied TBI screening
to a survivor of a cluster bomb
that went off right at his feet.
He was blown up, down, and
apart but "suspected" TBI
doesn't qualify until it is
medically proven.
This story in Salon
"I am under a lot of pressure
to not diagnose PTSD"
includes this quote
McNinch added that he also
received pressure not to
properly diagnose traumatic
brain injury, Sgt. X's other
medical problem. "When I got
there I was told I was
overdiagnosing brain injuries
and now everybody is finding
out that, yes, there are brain
injuries," he recalled. McNinch
said he argued, "'What are we
going to do about treatment?'
And they said, 'Oh, we are just
counting people. We don't plan
on treating them.'" McNinch
replied, "'You are bringing a
generation of brain-damaged
individuals back here. You
have got to get a game plan
together for this public health
crisis.'"
blast do not presume that you
were screened for traumatic
brain injury
Only the most obvious cases
were acknowledged by military
medical until recently.
DoD Avoided Brain Injury
Screening
AIG and CNA WILL NOT
authorize screening for TBI
CNA just denied TBI screening
to a survivor of a cluster bomb
that went off right at his feet.
He was blown up, down, and
apart but "suspected" TBI
doesn't qualify until it is
medically proven.
This story in Salon
"I am under a lot of pressure
to not diagnose PTSD"
includes this quote
McNinch added that he also
received pressure not to
properly diagnose traumatic
brain injury, Sgt. X's other
medical problem. "When I got
there I was told I was
overdiagnosing brain injuries
and now everybody is finding
out that, yes, there are brain
injuries," he recalled. McNinch
said he argued, "'What are we
going to do about treatment?'
And they said, 'Oh, we are just
counting people. We don't plan
on treating them.'" McNinch
replied, "'You are bringing a
generation of brain-damaged
individuals back here. You
have got to get a game plan
together for this public health
crisis.'"
Comments from the Brain Injury
Association of America on
RIN 2900-AM75-“Schedule for
Rating Disabilities; Evaluation
of Residuals of Traumatic Brain
Injury (TBI).” click here
Better brain trauma testing
called for in Iraq
Brain Injured troops face
unclear long term risks
New IOM Report Predicts Long-
Term Health Problems,
Including Neurological Disorders
Traumatic Brain Injury and
Suicide
Report to Congress Urges
Accelerated Efforts to Create
Breakthroughs on Traumatic
Brain Injury
Brain Trauma in Iraq
Thousands of U.S. soldiers have
survived powerful explosions in Iraq.
Many are returning home with brain
injuries that could result in long-term
disabilities.
Invisible Wounds of War
Veterans suffering from Brain Injuries
often have accompanying
impairments
The Delicate Brain
Association of America on
RIN 2900-AM75-“Schedule for
Rating Disabilities; Evaluation
of Residuals of Traumatic Brain
Injury (TBI).” click here
Better brain trauma testing
called for in Iraq
Brain Injured troops face
unclear long term risks
New IOM Report Predicts Long-
Term Health Problems,
Including Neurological Disorders
Traumatic Brain Injury and
Suicide
Report to Congress Urges
Accelerated Efforts to Create
Breakthroughs on Traumatic
Brain Injury
Brain Trauma in Iraq
Thousands of U.S. soldiers have
survived powerful explosions in Iraq.
Many are returning home with brain
injuries that could result in long-term
disabilities.
Invisible Wounds of War
Veterans suffering from Brain Injuries
often have accompanying
impairments
The Delicate Brain
