Sunday, December 19, 2010

Mild Traumatic Brain Injury

SGT Dixon, CPT Johnson
Most of the casualties seen at the FST were the result of some type of explosion.  Mild traumatic brain injury (MTBI) is a frequent occurrence.  Even with no outward signs of injury, the concussive blast can cause microscopic minimal brain damage.  The patient may have headaches, be irritable, show signs of depression, be unsteady on his feet, or have slight memory loss.

In the U.S., a person who presents in the emergency department of virtually any hospital with such symptoms will receive a CT scan of his brain to rule out more severe problems such as intracranial bleeding.  MTBI, however, will not show up on a CT scan.  It is a rather subjective diagnosis.  There are only 2 CT scanners in Afghanistan – at Bagram and Kandahar, the two large airbases.  If we medevaced every casualty that had potential MTBI for a CT scan, we would quickly run out of soldiers to accomplish the mission!  This was done early on during the war, and most soldiers never returned to duty.

2 Story Deck
FOB Shank has an MTBI clinic, run by CPT Johnson, an occupational therapist.  This clinic has been in operation for almost one year.  SGT Dixon, a certified occupational therapy assistant, assists CPT J.  When a casualty arrives at the FST, one of the MTBI staff members is present and does an assessment as soon as possible.  The patient will be asked to repeat lists of numbers, recite the alphabet in reverse, state the name of the President, etc.  They will receive an assessment of all cranial nerves to check for severe brain damage.  Anyone who shows signs and/or symptoms of brain damage is sent immediately for a CT scan.

MTBI Lounge
Those who appear to have MTBI will be sent to the MTBI clinic.  Here they will be completely removed from their unit and its activities for a couple of days to a week or more.  They will be able to relax in a comfortable environment with a comfortable bed and lounge area.  They may watch TV, play video games, and even bowl!  CPT J and SGT D are assessing and treating them during these activities.  Balance can be checked with Wii Fit.  Concentration can be assessed during games.  Long talks can reveal intimidation and depression.

One of the Bunks
Due to the intervention provided at the MTBI clinic, 99.7% of MTBI casualties have returned to duty this past year.  There have been no misdiagnoses of more severe brain damage.  This has kept the fighting force strong while conserving needed resources.  The program has been so successful that CPT Johnson has trained three additional teams that are currently deployed in RC East FOBs in Afghanistan, and an additional three teams are planned for RC South in the near future.

Bowling Alley
CPT Johnson is a unique individual, to say the least!  I like to think of him as a cross between a game show host and a used car salesman!  He has done an excellent job of selling the benefits of his program to the command structure and medical providers in the war zone.  He also has made the clinic a place where soldiers can come to relax and unwind.  An example of his resourcefulness has been his ability to network with colleges and universities to sponsor the clinic for a month at a time.  Clubs, fraternities and sororities will send “care packages” with clothing and goodies during their “month.”  They also usually send banners posters, t-shirts, etc. to demonstrate their school spirit.  Each of the bunks at the clinic has a particular school’s theme.

The views expressed in this blog are those of the author only, and not necessarily of the US Army or the US Government.  None of the information given is classified in nature.

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