The Gray Team Zeroed In On Subtle Effects Of IED Blasts : Shots - Health News A group of specialists called the Gray Team challenged the dogma that said head injuries were serious only if they were obvious and bloody. Bomb blasts can lead to lasting but invisible damage.

How A Team Of Elite Doctors Changed The Military's Stance On Brain Trauma

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Admiral Michael Mullen knew he had to do something more to care for troops injured by explosions when he met a young soldier in the hospital.

MICHAEL MULLEN: His mother was there, and he had one patch over his eye, and he was being treated for blasts. And I said, so how many? And he said, well, the 30th one finally got me.

SIEGEL: A couple of years later, Admiral Mullen formed a team. Its mission was to figure of what bomb blasts were doing to the brains of U.S. troops in Afghanistan and Iraq.


That elite team of officers transformed the military medical system and improved the care wounded troops receive. NPR's Jon Hamilton reports.

JON HAMILTON, BYLINE: The battle against brain injury began with a contentious job interview between the doctor who would lead the team and the man who would be his boss. It was 2008. An Army surgeon named Christian Macedonia had been told there was a high-level opening for a doctor who wanted to change the military's approach to battlefield brain injuries. At the job interview, he found himself face-to-face with Admiral Michael Mullen, chairman of the Joint Chiefs of Staff.

CHRISTIAN MACEDONIA: And he looks at me, and he goes, who are you and what are you doing in my office?

HAMILTON: Macedonia said, I'm here about the job. Mullen replied, I've decided I don't need a doctor on my staff.

MACEDONIA: And I said, sir, I'm going to disagree with you.

HAMILTON: Macedonia told the four-star admiral that if he really wanted to do something about brain injuries, he needed a doctor. He needed one with combat experience, strong scientific credentials and a high-level security clearance.

MACEDONIA: So I said, sir, you really only have one person, and that's me.

HAMILTON: Mullen smiled. He'd be giving Macedonia a hard time because he was looking for someone he might have to rein in but would never have to push.

MULLEN: And Macedonia fit that model for me perfectly. He was very outspoken, very straightforward. We talk about out-of-the-box thinkers. He just lives outside the box.

HAMILTON: Macedonia's first assignment was to assemble a team. He recruited four other military doctors with combat experience and impressive resumes. They were called the Gray Team, after the brain's gray matter. And Macedonia says their mission was to challenge something military doctors had been taught since World War I.

MACEDONIA: If you don't have blood coming out of you head, if you don't have a penetrating injury, you have not been injured.

HAMILTON: Macedonia believed that himself when he was deployed to Iraq in 2004. And then, he got caught in a mortar attack.

MACEDONIA: I was out with a young Marine. We were in the middle the attack, and the mortar was probably about 50 meters away.

HAMILTON: The blast wave shook them violently, but they weren't bleeding, so Macedonia went back to the hospital. He did surgery until midnight. Then, he headed for bed.

MACEDONIA: I had a shaving mirror hung up by my - by my cot, and I looked in that mirror, and I didn't recognize the person looking back at me.

HAMILTON: Macedonia realized that he couldn't remember anything from the operating room that night, and he recognized the vacant expression he saw in the mirror.

MACEDONIA: The same sort of strange look in the eye that I'd seen in people who had been in IED blasts up and down the route near our base.

HAMILTON: This wasn't a psychological reaction to combat. The blast had injured his brain. So by 2004, Macedonia had recognized the problem. Now, fast forward to 2008, he and the Gray Team were gearing up. IED's had become the weapon of choice for insurgents attacking coalition forces. Tens of thousands of soldiers were being exposed to bomb blasts. Many had memory loss, confusion and sleep problems. Admiral Mullen says the military still wasn't taking the problem seriously.

MULLEN: We would tolerate multiple blasts, deployment after deployment. And I was determined to see if I could do something about this - pretty significant.

HAMILTON: A few months later, Macedonia and the Gray Team made their first trip to Iraq and Afghanistan.

MACEDONIA: Quite simply, the Gray Team was there to establish ground truth with respect to traumatic brain injury.

HAMILTON: And the truth was pretty grim. Often, troops weren't even being checked for traumatic brain injury, or TBI. The military relies on something called the MACE exam to identify troops who have sustained a TBI or concussion. And Macedonia had been told the MACE exam was given to pretty much every service member near an explosion.

MACEDONIA: But then, you would go out, and you'd talk to these young medics and corpsmen, who are great patriots and doing wonderful things. And you would say, hey, son, how often do you administer the MACE exam? And they would look at you, and they would say, sir, I'm sorry. What's a MACE exam?

HAMILTON: Admiral Mullen says it was up to individual service members to report their own brain injuries.

MULLEN: If you were in a blast, you basically had one of two choices - you either didn't admit you had a problem, or if you admitted a problem, we put you on a plane and sent you home.

HAMILTON: And Mullen knew from visiting hundreds of wounded troops that they didn't want to get sent home.

MULLEN: The first thing they tell you is they want to get back in the fight. So nobody would admit they had a problem.

HAMILTON: When the Gray Team got back to the U.S., Macedonia says they found their ideas for reform weren't popular in the Pentagon.

MACEDONIA: I would literally have people behind closed doors say, who gave those people medical degrees? Who are they to tell me what - you know, I mean, literally.

HAMILTON: Macedonia says many senior medical officers just couldn't accept that there were real brain injuries you couldn't see on MRI or CT scans.

MACEDONIA: The organized military medical system was still trying to hold back the ocean and say, no big deal.

HAMILTON: In the Pentagon, some medical officers feared the financial costs of diagnosing more troops with TBI. Macedonia says bureaucratic concerns often seem to trump the growing scientific evidence that blast-induced TBIs were real.

MACEDONIA: I can't tell you the number of times I walked out of rooms just being sorely disappointed at people who knew what the right thing to do was, but chose to look the other way.

HAMILTON: The conflict between the Gray Team and the military medical establishment reached a peak over the issue of MRI scanners. Conventional scanners usually couldn't detect the damage from a blast. But the Gray Team now included David Brody, a civilian scientist from Washington University in St. Louis. And Brody had been using a new MRI technique to study troops at the U.S. military hospital in in Landstuhl, Germany.

DAVID BRODY: We went out there to Landstuhl, got our MRI scanner, started enrolling patients, started discovering immediately all sorts of injuries that were completely invisible to the conventional scans.

HAMILTON: Macedonia wanted to deploy this new kind of MRI to the battlefield, so during a Gray Team trip to Iraq, he made a pitch to a group of senior medical staff.

MACEDONIA: I said, we're very seriously considering putting MRI machines in theater. What say you? And I could've said, we're thinking about bringing a pile of radioactive waste to drop in your hospital.

HAMILTON: Macedonia eventually got his MRIs. That was partly because his boss, Admiral Mullen, had clout. As chairman of the Joint Chiefs, he was the highest-ranking officer in the armed forces. But Mullen and the Gray Team had also been building a coalition with some of the highest-ranking officers in the Army and Marines, and the Gray Team's allies outranked their opponents. Their ultimate victory came in 2010. The Department of Defense issued a new order for managing battlefield brain injury.

MULLEN: It required that if you are within 50 meters of a blast, you are going to be triaged. And at a minimum, you're going to be out 24 hours - literally out of combat.

HAMILTON: Mullen says he always knew he could beat the bureaucracy at some point. The day the new orders were issued, Macedonia brought him the news.

MULLEN: I can still remember Macedonia coming into my office and saying, Chairman, we got it - period. I mean, I just remember him sort of blurting that out.

HAMILTON: The 2010 mandate changed everything, and it was just the beginning. Today, combat troops often wear sensors that can tell when a bomb blast is strong enough to injure the brain. Military doctors are taught that blast waves really can cause physical brain injuries. And service members can ask for help with a TBI without worrying they'll be put on a plane and sent home. Jon Hamilton, NPR News.

SIEGEL: And you can read more about scientists fighting to protect U.S. troops at

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