While screenings performed immediately after returning from deployment might be successful in identifying physical symptoms, the process might allow gaps in detecting latent symptoms related to context.
Because certain emotional symptoms related to concussive injuries or combat stress emerge later than their physical counterparts, Lt. Gen. Eric Schoomaker, Army surgeon general, said, he advocates an additional screening three to six months after deployments.
Identifying the root of emotional symptoms may help affected service members avoid family, social, alcohol or other problems resulting from a lack of proper diagnosis and treatment.
Speaking at the Military Health System conference in late January Col. Kenneth Cox, USAF, said that personal health assessments by service members after deployment now include questions on Traumatic Brain Injury and alcohol.
He said 75 percent of service members who have deployed have filled out the assessments before leaving theater and again three to six months after returning home.
“Fifteen percent request a referral,” he said, and about 30 percent of those receive a referral for additional mental health care. “We never want people not to seek care before taking assessment.”
Cox said that guardsmen and reservists express more concerns about their physical and mental health than service members in the active component.
Col. Charles Hoge, co-author of three major studies of soldiers and marines returning from Afghanistan and Iraq and director of the division of psychiatry and neuroscience at Walter Reed, said, “There’s a lot we don’t know about these injuries [Post Traumatic Stress Syndrome and Traumatic Brain Injury], but we do know that context is important,” such as blacking out.
“Being in combat you’re going to be in a physiologically heightened state already. Now imagine a blast knocks you unconscious – an extremely close call on your own life, and maybe your buddy went down. So you’ve got the trauma, and maybe the effect of the concussion makes it worse,” he said.
In Iraq, Col. Leo Tucker said, “We’ve created a more simplified record” to look for Traumatic Brain Injury at point of injury but the service need to create a form of testing to determine with a member “can return to duty, take a knee or back to treatment” at Landstuhl Regional Medical Center in Germany.
At Landstuhl, Col. Bruce Lein told attendees at the Military Health System conference, “We screen everybody coming by whether they got a hernia … or wounded. The question is: ‘What are we screening them for’? We’ve got to do a better job of screening them in theater.”
The questions are: “What’s the diagnosis?” and “What’s the treatment?”
Speaking at the Military Health System conference, Col. John Holcomb, director of the Army’s Institute of Surgical Research, said a serious look at how these injuries occur on the battlefield was needed. But “we don’t want to study this to death.”
About 85 percent of service members with concussive injuries recover. Cox said the Defense Department is treating about 1,500 cases of Traumatic Brain Injury and about 1,100 cases of serious injury.