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This article appeared in The Year in Veterans Affairs & Military Medicine, 2005-2006 Edition , published by Faircount Media Group. (Click here to see a pdf of this article.)
The Silent Injury Comes Home from War
by Barbara Stahura
by Barbara Stahura
The term “IED” has found its way into common parlance as the war in Iraq and Afghanistan continues. It stands for “improvised explosive device.” While the word “improvised” seems to suggest a thrown-together, homemade bomb that might or might not work, the reality is much more terrifying. At least one IED produced enough deadly force to lift and flip a 25-ton armored vehicle off a roadway, killing the 14 Marines inside. Others turn cars into bombs that explode on street corners, killing or injuring civilians and military personnel who happen to be nearby. Others strapped to people become living bombs. IEDs have become the signature weapon of the insurgents. And one of the injuries they cause is becoming the Iraq war’s signature injury: traumatic brain injury, or TBI.
Traumatic brain injuries are caused by external force and can result from many things: vehicle accidents, getting whacked on the head too hard during a football game or a boxing match, falls, domestic or street violence, gunshots, shaken baby syndrome. In the United States, according to the National Institutes of Health, TBI is “a disorder of major public health significance,” striking more than 1.5 million people every year, with currently more than 5 million suffering permanent and damaging disabilities. And with this war, it appears that larger than usual numbers of military personnel are sustaining TBIs. This is due in large part to IEDs, although bullets, land mines, and rocket-propelled grenades are doing much damage as well. In fact, all these devices are responsible for 70 percent of injuries in Iraq and Afghanistan.
Some TBIs come from wounds that penetrate the skull and the brain. These “open head” wounds are obvious and often horrendous. But others come from “closed head” injuries that can be invisible even to the most sophisticated neuro-imaging machines. A blow to the head that doesn’t even bruise the skin can cause one of these, and so can an explosion’s “concussive impact,” something against which helmets offer no protection.
Here’s why: The brain is the consistency of Jell-O, and it floats within the hard skull. When a powerful explosion’s blast wave—a shock wave of highly pressurized air followed by a blast wind of incredible force—collides with a human body, that body accelerates uncontrollably. And even if the head does not hit anything, the brain, which at first accelerates along with the head, instantly decelerates as it slams into the skull, and then it rebounds or, even deadlier, it twists. The area through which the blast wave
Traumatic brain injuries are caused by external force and can result from many things: vehicle accidents, getting whacked on the head too hard during a football game or a boxing match, falls, domestic or street violence, gunshots, shaken baby syndrome. In the United States, according to the National Institutes of Health, TBI is “a disorder of major public health significance,” striking more than 1.5 million people every year, with currently more than 5 million suffering permanent and damaging disabilities. And with this war, it appears that larger than usual numbers of military personnel are sustaining TBIs. This is due in large part to IEDs, although bullets, land mines, and rocket-
Some TBIs come from wounds that penetrate the skull and the brain. These “open head” wounds are obvious and often horrendous. But others come from “closed head” injuries that can be invisible even to the most sophisticated neuro-
Here’s why: The brain is the consistency of Jell-
