Army Moves To Act Fast On Battlefield Brain Injuries Traumatic brain injuries are often caused by a blast: A bomb explodes, and the concussive effect violently shakes the brain. The Army has had a mixed record treating soldiers for TBI. Now it's trying to spot the injury close to the battle and get soldiers out of the fight.

Army Moves To Act Fast On Battlefield Brain Injuries

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It's MORNING EDITION, from NPR News. Good morning. I'm Renee Montagne. Afghan President Hamid Karzai says peace talks are underway with the Taliban and the United States. That revelation last week has also put new emphasis on a long-term partnership agreement for the future of the U.S. military in Afghanistan.

That partnership was part of the conversation yesterday, when a group of U.S. senators met with Karzai in Kabul. Of course, American soldiers are still very much in the fight, and sometimes the wounds that they suffer can't be detected. One of those injuries is called traumatic brain injury, or TBI. It's often caused by blasts, like when a roadside bomb explodes and the concussive effect violently shakes the brain inside the skull.

Sometimes there are symptoms. Sometimes there are not. The Army in particular has had a mixed record of treating its soldiers for TBI. Now it's trying to spot the injury close to the battlefield and get injured soldiers out of the fight.

NPR's Quil Lawrence sent this report from Kandahar.

QUIL LAWRENCE, BYLINE: Nineteen-year-old Army Private Cody Dollman has a look in his eyes that makes you think he probably used to fight much bigger kids than him on the playground back home in Wichita, Kansas. He says he always wanted to be a soldier. Both his grandfathers served in the military, but he's the first in his family to have seen action overseas.

Dollman had been patrolling the battle-scared villages around Kandahar.


LAWRENCE: What do you love about it?

DOLLMAN: It's what I signed up to do, you know? Yeah, I get to go back home and tell stories. You know, that's one of the coolest things.


DOLLMAN: What did you do on Christmas? Man, I got blown up. Yeah.


LAWRENCE: Dollman isn't joking. Since he deployed last April, he's been blown-up three times by roadside bombs that hit his convoy of armored trucks. The third time was the worst.

DOLLMAN: We were rolling on a mounted patrol, and I was in the lead vehicle, which hit an IED. I hit my head, blacked out for a little bit.

LAWRENCE: At first, Dollman shook it off as his platoon pursued the insurgent fighter who set off the bomb. They killed the man. Dollman says he doesn't want to talk about that. Within an hour, he was feeling the after-effects of the blast. He threw up, and his head hurt. The medic said Dollman was a sure bet for TBI: traumatic brain injury. He wanted to stay with his platoon, but the medic wasn't having it. A chopper flew him to the hospital at Kandahar Airfield.

DOLLMAN: It's one of those things that if you're treated, shouldn't be anything to worry about, as long as you're, you know, not stubborn like me.

LAWRENCE: Problem is, most soldiers - and many of their leaders - are a bit stubborn like Private Dollman. Soldiers don't like being taken away from their unit, especially for an injury they can't see.

Medics began carrying a laminated quiz that tests a soldier's ability to concentrate, but they soon found that the soldiers were memorizing the answers. Now the medics carry several different versions of the quiz.

But that touches on a challenge with TBI: how to diagnose it. The symptoms aren't always as obvious as Pvt. Dollman's. Sometimes there aren't any obvious symptoms at all.

MAJOR GENERAL RICHARD THOMAS: Everyone wants a pregnancy test for TBI.

LAWRENCE: Major General Richard Thomas, a surgeon, just finished a tour as lead medical advisor to U.S. forces in Afghanistan. He says someday a blood test or brain scan may be able to indicate whether a soldier has TBI or doesn't. The Army is researching both. But General Thomas says those tests cold be years away.

THOMAS: While that's working, that takes time. What are we going to do immediately? Immediately, we've got to identify these guys as soon as we can, get them out of the fight. Because we know that for a concussion, the best thing to do immediately is take them away from the insult, rest them, let their brain recover.


LAWRENCE: That's what happens at the newly completed concussion care center at Kandahar Airfield, where Private Dollman is currently on bed rest. The facility has neurologists and occupational therapists. There's even an MRI machine in a trailer - a first in military field hospitals.

Once the soldier is here, it's easier to start tackling symptoms. But that's another tricky thing about TBI. Navy Commander Greg Caron, a clinical psychiatrist, says that the symptoms for TBI are easily mixed up with symptoms for other battle injuries like post-traumatic stress disorder, or PTSD.

COMMANDER GREG CARON: What's interesting about blast-related concussion is that it impacts the same region of the brain that is implicated in anxiety disorders and mood disorders. So about a third of the folks who are diagnosed with MTBI or concussion actually have other psychiatric diagnosis, whether that's depression or PTSD.

LAWRENCE: So the challenge for doctors is to figure out which symptoms are from TBI and which aren't. Like PTSD, some victims don't feel any effects until months after their injury. In fact, the Army's own studies show that as of a couple years ago, most cases of TBI in Iraq went undiagnosed. Critics say the military took a long time to realize the enormity of the problem. That raises another issue, though: for the majority of both wars, the Army kept little data on concussions.

The Kandahar Concussion Care Center is trying to correct the military's course on TBI. Private Cody Dollman takes brain scans regularly. He takes cognitive tests almost every day. He recently got the news - bad news, if you ask him - that he can't go out on any more patrols.

DOLLMAN: I'm not allowed to leave the wire as of now, just because it's my third.

LAWRENCE: Third concussion. That's one rule military doctors have come up with since they've been looking at TBI close to the fight. It's arbitrary. No one knows if one concussion or five concussions lead to the long-term problems, but doctors think it's a good rule of thumb. Dollman decided he would probably lose an argument with the neurologists here in Kandahar.

DOLLMAN: It is hard, but I know it's for a reason, because I know I need to get treated. That way, I'm not hurting my platoon, because when we go on missions, it's - they can't be worrying about me. They've got to be worrying about other people than just me. So I know if - I'm more of a danger going out on the line with TBI. So it's a big thing I get treated here before I go back out.

LAWRENCE: That argument works with soldiers. They'll do for the guys in their unit. Another argument may be winning over their commanders. According to General Thomas, the new procedure - getting soldiers to take a break and rest up but stay in Afghanistan - is actually getting troops back to the battlefield sooner. Before, many soldiers thought to have TBI would be flown all the way to Germany for treatment. Many would never get back to their units in Afghanistan. Keeping soldiers healthier but also getting them back to the fight are the kind of results that may help senior military leadership embrace the new approach to TBI. Quil Lawrence, NPR News.

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