PTSD and mild TBI
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WASHINGTON (Army News Service, Aug. 1, 2007) - The Army launched its Post Traumatic Stress Disorder and mild Traumatic Brain Injury chain-teaching program at the Pentagon last week by training flag officers and Army senior executive service civilians how to recognize and help distressed Soldiers who may or may not recognize their unseen injuries.

Announced by the Army July 18, the PTSD and mild TBI program is mandatory for all active-duty and reserve-component Soldiers, from the highest to lowest levels in the chain of command. More than one million Soldiers are expected to receive the same training as the senior leaders within 90 days.

Lt. Gen. James L. Campbell, director of the Army Staff, opened the training by telling his peers that the biggest teaching point he wanted to get out to the Army's leaders involved a cultural shift in thought - that leaders shouldn't assume that because Soldiers have no visible injuries that all is well mentally.

"We're going to take this down to the platoon level to encourage candor and to ensure face-to-face contact," Lt. Gen. Campbell said. "I will take what I hear today and go back to the office and teach what I've learned to a colonel, two majors and two NCOs. That's the way this training will work."

Dr. (Col.) Elspeth Cameron Ritchie, psychiatry consultant to the Army Surgeon General Health Policy and Services Directorate and the chief developer of the chain teaching project, started the session by telling the leaders that PTSD and mild TBI were not the same, but Soldiers could experience the effects of both simultaneously.

"PTSD and mild traumatic brain injury or concussion are wounds of war that aren't visible, so sometimes we miss them," she said. "It's critically important all Soldiers be able to recognize these unseen wounds of war, both to help their buddies and to help themselves. Furthermore, we need to make sure every leader knows about concussions, mild TBI and PTSD, so that they can help those they take care of."

Dr. Ritchie took the senior leaders through the standardized script and supporting audio-visual products which describe PTSD and mild TBI and what symptoms to look for.

According to the video, mild TBI has become so common in the Iraq theater of operations, it's considered a signature and unseen wound of the conflict. Roughly two-thirds of injuries are caused by blast events, with about 40 percent of injured Soldiers showing evidence of mild TBI or concussion.

"It can be caused by motor vehicle accidents, a significant blast or even sports, but no matter what the cause every case of mild TBI needs to be evaluated. We recommend anyone who is involved in a blast or any kind of direct trauma to their head visit their local aid station," Dr. Ritchie said. "Any Soldier who is nauseous, has blurred vision, sees 'stars' or has dizziness needs to be evaluated as soon as possible."

Treatment and recovery for mild TBI are usually a simple process that involves simply rest and relation for a few days, but it's important for Soldiers to not neglect seeking treatment and for their fellow comrades-in-arms to let their chain of command know when they suspect a battle buddy is suffering from concussion. The key to recovery from concussion is time, knowledge and education, Dr. Ritchie added.

She cautioned that should a Soldier suffering from a concussion return to duty too early and become involved in another blast or accident, that Soldier could suffer irreversible brain damage.

Soldiers diagnosed with mild TBI should ensure their medical records are updated for future reference, she said.

Addressing PTSD, Dr. Ritchie also said no amount of training can totally prepare a Soldier for the realities of combat. Most will do well but, for some, persistent symptoms can include re-experiencing the event through nightmares, jumping at loud noises, or feeling keyed up or on edge all the time.

"We know from the mental-health advisory teams and other sources that between 20 and 30 percent of U.S. military personnel returning from combat operations report these psychological symptoms; they have sleep problems, feel depressed and have difficulty in their relationships," Dr. Ritchie said. "Most Soldiers will transition in a normal, healthy way, but some will take a little longer than others."

"Sometimes though, even the strongest of Soldiers are affected so severely that they need additional help," she said, "so it's important for leaders and Soldiers to be aware, recognize symptoms and watch for them in themselves and in their fellow Soldiers."

The Army provides many sources to help Soldiers suffering from PTSD and mild TBI or other behavioral-health problems. These include chaplains, deployable stress-control teams, medical and behavioral-health clinics, and the Military One-Source hotline at 1-800-342-9647.