By Michael J. PachMarch 5, 2007
FORT CARSON, Colo. (Army News Service, March 6, 2007) - Six members of the Office of the Surgeon General Traumatic Brain Injury Task Force visited Fort Carson Feb. 20-22 to evaluate current TBI practices as part of an Army-wide study on the treatment of TBI.
The task force was formed by Army Surgeon General Lt. Gen. Kevin C. Kiley in January in response to the increasing number of TBI cases reported by Soldiers returning from combat. The task force's mission is to analyze the way the Army addresses TBI care and to make recommendations for the improvement of TBI prevention, identification, assessment, treatment, rehabilitation, family support and the transition to civilian life of Soldiers with TBI.
"We're looking for identifying best practices in terms of the management and the screening tools for the TBI patient," said Col. Judy Ruiz, task force nurse case manager, OTSG. "We're looking at prevention, we're looking at education, and we're looking at different gaps that exist in current practices so we can provide recommendations to the Surgeon General (Kiley) in terms of where we need to go in the management of the traumatic brain injury of Soldiers."
The task force will submit a report to Kiley detailing its assessment and recommendations for improving care for TBI patients by May 17.
TBI is defined as a trauma to the head (blow, jolt or penetrating wound) accompanied by a change in mental status such as a loss of consciousness, loss of memory of events immediately before or after the trauma, or feeling dazed, disoriented or confused.
TBI can result in such cognitive, emotional, behavioral and physical problems as impaired attention, decreased memory and problem-solving skills, depression, anxiety, irritability, diminished motivation, seizures, headaches and dizziness. These symptoms may go away hours or days after a trauma, but those with lasting symptoms should be checked out by a medical provider.
Fort Carson is the first training post visited by the task force and was chosen because of its unique approach to TBI. The Soldier Readiness Center screens 100 percent of the Soldiers returning from combat for TBI plus those arriving from other posts.
"We actually came here because it (the Fort Carson SRC) is regarded as one of the best models for looking at traumatic brain injury," said Ruiz. "I'm really impressed."
According to Col. Heidi Terrio, chief, Department of Deployment Health, Evans Army Community Hospital, the SRC has screened 13,500 Soldiers for TBI since June 2005. Screenings are conducted during the Post Deployment Health Assessment, three to five days after their return, and during the Post Deployment Health Reassessment, 90-180 days later. A one-page questionnaire is used to ask Soldiers about injuries and symptoms related to any head trauma experienced while deployed.
If Soldiers show TBI symptoms during a screening at the SRC, they are evaluated by either Dr. Ivan Covas, TBI practitioner, or Katherine Scally, SRC TBI coordinator and nurse practitioner.
Covas and Scally determine whether referred Soldiers need further evaluation or a specialty referral; medication for sleep problems, headaches or irritability; or behavioral education to improve their memory. Soldiers determined to be non-deployable are assigned a nurse case manager who helps coordinate their treatment. Spouses and co-workers also play a key role in a Soldier's treatment by noticing improvements in behavior.
Personnel at the SRC have seen an increase in reports of TBI symptoms in Soldiers at the PDHRA as compared to the PDHA. Terrio attributes the increase to the fact that they are out of the combat zone and living more normal lives. Since they are away from the stress of combat and are now dealing with everyday problems, they realize they are showing symptoms and/or their spouses indicate that their behavior has changed.
The task force conducted a town hall meeting Feb. 21 at EACH with Soldiers cur receiving treatment for TBI. The Soldiers were asked to share their experiences and provide feedback on what is working and what isn't.
One of the topics discussed during the town hall meeting was the stigma Soldiers feel is associated with TBI. Some fear ridicule from their peers or that admitting they have a problem could end their careers.
"I think it (the town hall meeting) was a great forum to have the Soldiers address their issues and concerns, but I think it's unfortunate that they still feel that there's still a lot of stigma associated with traumatic brain injury," said Ruiz. "I think that it is so crucial to share that information with their buddies because their buddies are the only ones out there who are going to be able to watch out for these symptoms and prevent further injury."
Covas and Scally have their own way of helping Soldiers deal with the stigma associated with TBI.
"Let me tell you what you are not," says Covas to his TBI patients. "You are not crazy, you don't have post traumatic stress disorder and you're not losing your mind. These are symptoms because your brain got shaken. This is not a career-ending condition. These symptoms will be treated, and you'll get better."
Many cases of TBI are the result of the detonation of improvised explosive devices. Covas said that the impact these concussive events have on the brain is unknown because the injuries sustained from IED blasts have not been seen before. He also said that the majority of information currently available to doctors comes from the study of sports injuries. The findings from the treatment of patients at the SRC indicate that the injuries from IEDs are much different, and Covas is confident that change is on its way.
"A whole new re-evaluation and criteria for diagnosis of traumatic brain injury is going to happen, and it's going to come from the Army," said Covas. "There is not doubt that the Army is going to change medicine in the future when it comes to traumatic brain injury."
"We want them (TBI patients) to have the best (care) because they deserve it," said Ruiz.
(Michael J. Pach writes for the Fort Carson "Mountaineer.")