Traumatic Brain Injury and Post Traumatic Stress Disorder have become known as the "signature wounds" suffered by combat veterans returning from the Global War on Terrorism. Soldiers may not know they have suffered such a wound.

According to the Department of Defense 11, 945 Soldiers suffered some form of a TBI in 2007. The numbers for 2008 are incomplete.

If the head is hit or shaken, a concussion or closed head injury can result. Concussions are seldom life threatening. Doctors often use the term "mild" when the person is only dazed or confused or loses consciousness for a short time.

However, concussions can result in serious symptoms, and people who survive multiple concussions may have problems that are more serious.

Common symptoms of TBI can be:
Aca,!Ac Feeling light-headed or dizzy
Aca,!Ac Difficulty organizing daily tasks
Aca,!Ac Blurred vision or eyes tire easily
Aca,!Ac Headaches or ringing in the ears
Aca,!Ac Feeling sad or anxious
Aca,!Ac Easily irritated or angered
Aca,!Ac Feeling tired all the time
Aca,!Ac Trouble with memory, attention or concentration
Aca,!Ac More sensitive to sounds, lights or distractions
Aca,!Ac Impaired decision-making or problem solving
Aca,!Ac Difficulty inhibiting behavior, impulsiveness
Aca,!Ac Slowed thinking, moving, speaking or reading
Aca,!Ac Easily confused or feeling easily overwhelmed
Aca,!Ac Change in sleep pattern

Some symptoms may be immediate while other symptoms can appear much later.
To promote healing, people should get plenty of rest, increase activity slowly, write things down that they have trouble remembering, establish a daily routine, and only do one thing at a time.

Avoid activities that could lead to another injury, such as contact sports.
Avoid alcohol; caffeine; pseudo ephedrine contained in some over the counter cough, cold and allergy medications; and excessive use of over the counter sleep aids.

TBI from a car accident is distinguishable from a TBI that has elements of Post-Traumatic Stress Disorder resulting from a combat injury such as the explosion of an Improvised Explosive Device.

Symptoms of PTSD can sometimes mask a mild TBI. If the symptoms persist for weeks to months, it is more probable that the real issue is PTSD.

According to Dr. Gerry Grace at the Army Medical Department Center and School, "PTSD can be the gradual, silent but cancerous intrusion into a Soldiers life that eats away at the quality of his or her individual and Family life."

PTSD can develop after a life-threatening experience, such as combat. Soldiers who have experienced threatened death or serious injury, causing an emotional reaction of intense fear hopelessness or horror may be experiencing PTSD.

People with PTSD may have various kinds of experiences for weeks, or even months after the event is over. They may re-experience the event over and over in their mind; have repeated nightmares about the event; vivid memories, almost like it was happening all over again; or a strong reaction to a sound, reminding them of the event, such as a car backfiring. They may avoid people, places or feelings that remind them of the event.

They may also feel keyed-up or on-edge, startle easily, be irritable or angry for no apparent reason, be hyper-vigilant to their surrounding and have trouble relaxing or sleeping.

The AMEDDC&S is actively addressing the growing number of cases of TBI and PTSD by implementing the Provider Resiliency Training Program.

PRT program focuses on the medical provider who may have high caseloads, works very long hours, and has a high acuity of Soldiers with mild TBI, PTSD and physical challenges. The combination can lead to high levels of stress among providers placing them at risk for fatigue or burnout.

PRT is an interactive, continuing process of self-care and prevention designed to improve not only a provider's ability to perform their mission but to enhance their quality of personal and interpersonal life.
The AMEDDC&S offers two programs within the Army Medical Command.
The first program involves the placement of Provider Resiliency Trainers at major medical training facilities to foster an environment of self-care and resiliency among care-providers. The PRT trainers conduct two-hour classes that define provider fatigue and burnout. In this class, a self-care plan looks at ways to improve mental, emotional, physical, spiritual and social well-being.

The second program that is in development for launch in early summer includes a resident course to enhance professional resiliency. The Professional Resiliency Resident Course targets professional medical staff such as doctors, nurses, and ancillary staff. This program focuses on the most advanced research, concepts, and theories related to self-care management. Attendees will have the opportunity to participate in various practical learning activities that involve self-help techniques. By using personal introspection, participants will focus on internal and external stressors that contribute to burnout and compassion fatigue.

"Through these programs, there is an opportunity for us to reflect on what makes us strong and what, if thoughtfully considered and consistently applied, could make us both stronger and wiser as we meet the continual challenges of our times," said Cheryl Camarillo, PRT team leader, AMEDD Center and School.