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Joint Staff Doctor Explains TBI Diagnosis Procedures

Feb. 24, 2020 | BY Jim Garamone , DOD News

Traumatic brain injuries can't be quickly diagnosed — as was the case with the Iranian missile attack on Al Asad Air Base in Iraq on Jan. 8, the Joint Staff surgeon said.

At a Pentagon news conference today, Air Force Brig. Gen. (Dr.) Paul Friedrichs said 110 service members have been diagnosed with mild traumatic brain injuries from the attack. Most have returned to duty, while 25 returned to the United States for further treatment, he said, and six more are still undergoing testing.

Following an attack, commanders assess injuries, Friedrichs said, and in this case, no one immediately appeared to have had acute injuries. "No one lost a leg, no one lost an eye, no one lost a limb — which was remarkable given the strength of these munitions," the doctor said.

Bulldozer moves dirt.
Crew Operation
Soldiers with the South Carolina Army National Guard’s 124th Engineer Company, attached to the 206th Engineer Battalion, operate a front-end loader at Al Asad Air Base, Iraq, Jan. 23, 2020. The crew fortified defenses after a ballistic missile attack.
Photo By: Army Spc. Derek Mustard
VIRIN: 200123-A-DS044-1091M

Therefore, he explained, reports went up the chain of command saying no one had an acute injury. But a TBI takes time to diagnose, and the process is involved. Protocols call for TBI testing of service members who were within 50 meters of an explosion, were exposed to a series of explosions, had a direct blow to the head, or who exhibit symptoms such as headache, dizziness, memory problems, balance problems, nausea, vomiting, difficulty concentrating, irritability and visual disturbance.

The tests take up to two days to complete. But service members may have TBI and feel they can power through and just go back to duty. They may have symptoms, but they don't go away and may get worse, Friedrichs said.

News crew sets up.
Broadcast Crew
News agency camera operators set up broadcasting equipment at Al Asad Air Base, Iraq, Jan. 13, 2020. Military officials invited international news agencies to participate in a media event at Al Asad in the aftermath of ballistic missile attacks.
Photo By: Army Spc. Derek Mustard
VIRIN: 200113-A-DS044-1759

"A lot of people have said, 'Well, why didn't we immediately identify everybody with a traumatic brain injury?'" the general said. "[It's] because the signs sometimes are fairly nonspecific. And … even though we've trained everybody who deploys downrange on what to look for, it's quite common that we'll have folks who will say, 'I just was blasted. Of course, I'm not going to feel quite right. I'm going to ride this out for a few days.' Or 'I'm going to wait and see if this gets better.' And then they come in several days or weeks after the fact."

While there are tests that can point to TBI, some cases also require an MRI. The closest MRI testing facility to Iraq is in Germany, adding to the delay in diagnosis.

Airman walks through debris.
Salvageable Search
A U.S. airman searches for salvageable items after missile attacks at Al Asad Air Base, Iraq, Jan. 12, 2020.
Photo By: Army Spc. Derek Mustard
VIRIN: 200110-A-DS044-1094

The department takes TBI extremely seriously, the doctor said, and has invested $1.5 billion in diagnosing and treating the condition. Test groups are wearing sensors to measure blast effects that could give medical professionals better information when making diagnoses, he noted.

"I think that's going to be really exciting going forward because that takes some of the subjectivity out," he said. "There is no military in the world that has invested as much or has fielded as many evidence-based tools as what we have right now."