Systems Engineering to Improve Traumatic Brain Injury Care in the Military Health System Workshop Summary (2009) / Chapter Skim
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3 Traumatic Brain Injury and the Military Health System--Michael S. Jaffee
3 Traumatic Brain Injury and the Military Health System--Michael S. Jaffee
Pages 31-48
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combat zone were classified as having at least a head or neck injury. This chapter is based on the author's presentation and responses to questions during the plenary session of the NAE-IOM workshop on Harnessing Operational Systems Engineering to Improve Traumatic Brain Injury Care in the Military Health System on June 11, 2008.
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Information from the Joint Theater Trauma System (JTTS) indicates that about 40 percent of soldiers exposed to a blast have evidence of a TBI; Defense and Veterans Brain Injury Center (DVBIC)
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. All of these sources report that the incidence rate of TBI ranges from 10 to 20 percent (Traumatic Brain Injury Task Force, 2007)
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for Psychological Health and Traumatic Brain Injury. DCoE is described as a "Center of Centers," comprising the (aforementioned)
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and surgical care, reconditioning and rehabilitating services for those returning to duty in theater, stabilization for further evacuation Level V Medical center Comprehensive Walter Reed Army diagnostic, medical, Medical Center; psychological, National Naval Medical surgical, and Center (Bethesda) rehabilitative care Sources: Jaffee, 2008; Jenkins et al., undated; Rasmussen et al., 2006.
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; high-velocity gunshot wounds, blast injuries, and multiple traumas are common. In a stateside civilian facility, less than 10 percent of admitted trauma patients require surgery, and most of those require only one surgical specialty, whereas most patients admitted to the Balad AFTH need surgery, and the majority require more than one specialty and multiple procedures.
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The educational component of a program for TBI includes clinical training for providers who render care in theater, during pre-deployment and deployment, and back in CONUS. The training includes programs intended to increase the awareness of TBI by service members and their commanders, not only to improve care, but also to reduce the stigma In general, the clinical information (Class 1 randomized controlled trial)
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located in Minneapolis; Palo Alto; Richmond, Virginia; and Tampa. PRCs include brain injury centers (VA's component of DVBIC) , which provide a full range of acute, comprehensive medical and rehabilitative services to patients with highly complex injuries, including an emerging consciousness program for patients with severe TBI to facilitate their return to awareness and improve responsiveness.
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The Medical Communications for Combat Casualty Care system and its Armed Forces Health Longitudinal Technology Application-Theater are also intended to systematize the collection of medical information in the field. JTTS also facilitates other DOD-wide collaborations in trauma management, policy development, research, education, medical resource allocation, and clinical care (DOD, 2008)
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Table 3-3 categorizes blast injuries by mechanism. Briefly, a primary blast injury is caused solely by the direct effect of blast overpressure on tissue.
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or blunt injuries device and surrounding environment • Eye penetration Tertiary Displacement of the person by the blast or • Fracture and traumatic amputation debris impact • Stripping of soft tissues • Skin speckling with explosive product residue • Blunt injuries • Crush injuries Quaternary Exposure to the heat and fire by-products • Burns from radiant and convective heat generated by the blast • Injury or incapacitation from inhaled toxic fire gases Quinaryb Exposure to toxic agents released by the blast • Illnesses, injuries, or diseases caused by chemical, biological, or radiological substances (i.e., "dirty bombs") a "Blast lung injury (BLI)
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have reported a genetic change, alternation in the expression of inducible nitric oxide synthetase. Another complication in the analysis of TBI in combat situations is that most blast injuries involve other modalities, a circumstance that has been called "blast plus." A soldier riding in a HMMWV (popularly Cavitation is the sudden formation and collapse of bubbles in liquids (blood or cerebral fluid, for example)
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Clinical Assessment Military health care providers also face many other controversies. Perhaps the most basic is the definition of TBI itself.
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, the Army Surgeon General's TBI Task Force (Traumatic Brain Injury Task Force, 2007) , a group constituted by DOD to review operations at Walter Reed and National Naval Medical Centers (Independent Review Group, 2007)
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2006. Traumatic Brain Injury in Military Service Members–2006-02.
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Presentation at the Workshop on Harnessing Operational Systems Engineering to Improve Traumatic Brain Injury Care in the Military Health System, The National Academies, Washington, D.C., June 11, 2008.
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2008. Understanding sequelae of injury mechanisms and mild traumatic brain injury incurred during the conflicts in Iraq and Afghanistan: persistent postconcussive symptoms and posttraumatic stress disorder.
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