At War Blog: Concussion in War Zones
Commander Earl Frantz is the officer in charge of the Concussion Restoration Care Center at Camp Leatherneck in Afghanistan, the first multidisciplinary concussion rehabilitation clinic set up in a war zone.
CAMP LEATHERNECK, Afghanistan — The idea of treating warriors for concussion during the acute phase in the war zone is a new concept.
During the first nine years of war in Iraq and Afghanistan, if a service member was not bleeding or visibly broken on the battlefield, he shook off any cobwebs in his head from an attack and returned to the fight.
“Please set me up with someone to talk to so that I am not a jerk to my wife and kids when I get home.”
— Anon. Marine Sergeant
As the improvised explosive device, or I.E.D., became the enemy’s weapon of choice, an unprecedented number of warriors were returning from battle with invisible wounds. Concussion, often called mild traumatic brain injury, is now the most common battlefield injury, affecting more than 300,000 service members since 2001.
The battlefield concussions that our warriors experience are on a different level than the typical sport concussions. Being knocked out on the gridiron can be bad. Experiencing a concussion because a comrade stepped on a land mine is horrifying. Both were concussed. The warrior however has much deeper wounds in his mind and spirit. Not treating these intangible, yet equally real injuries, may lead to long-term functional problems.
The Blast
Caring for these warriors over the last six months has been the highlight of my career. I can think of no other patient interaction that typified my experience more than an appointment I had a week ago. When the Marine sergeant walked into my exam room, the dried blood on his face made it evident that he had recently been in battle. Despite seeing hundreds of concussed patients, his demeanor and composure surprised me. Normally when we see a warrior just coming out of battle he is frequently withdrawn and visibly troubled. Though the Marine appeared concussed – processing his thoughts a bit more slowly than usual – he had an uncanny focus and a resolve. He recounted his story to me in detail.
Just 16 hours before our meeting, he was leading his sniper team on a combat patrol. His best friend was walking in front of him when it happened. The sergeant felt like someone threw him to the ground, and his vision immediately blurred. As he scrambled to his knees live rounds were landing close by, and his friend called for help. Although dazed and unable to see clearly, he realized his brother in arms had stepped on an I.E.D. He directed his squad to take cover and called in an airlift request. The Navy corpsmen applied a tourniquet to his comrade’s upper thigh, and they both were taken to a landing zone.
While waiting for the arrival of the air evacuation helicopter, he held his best friend’s hand.
They laughed together because his friend lost only one leg, while his genitals — affectionately referred to as “my junk” — were uninjured.
Two Requests
On the way to the combat hospital, the medic flushed the sergeant’s eyes. He was then able to see clearly, and for the first time he looked down at his best friend and saw him in a sleeplike state. He recounted how, as his eyes panned down, he felt sick, seeing a mangled left leg with exposed bone and flesh. His friend’s right leg was visibly deformed, contorted into the shape of the letter L. When they arrived at the hospital, the sergeant was admitted to the ward, and his friend was taken immediately to the operating room. Ten hours later he said goodbye to his friend, who was evacuated to the next level of care in Germany.
Just 16 hours from his injury, this battle weary, sleep-deprived Marine Corps sergeant walked into my life. After recounting the story, he looked me straight in the eye and said, “Doc, I only have two requests.” This was odd but intriguing. My experience told me that he would want to have a certain medicine, perhaps a phone or a place to sleep. He first asked that I get him back to his men as soon as possible. Semper fidelis – always faithful — is the Marine Corps motto. His second request: “Please set me up with someone to talk to so that I am not a jerk to my wife and kids when I get home.”
I am sure this young enlisted Marine was not familiar with the research linking chronic physical and psychological disability to Post Traumatic Stress Disorder. What he did know was that he had seen horrific things, was under a great deal of stress and needed help.
The Treatment
Over the next week this warrior was treated for concussion, combat stress, emotional scars and musculoskeletal injuries. He saw a physical therapist, a chaplain, a family physician and a clinical psychologist all under one roof. During this week, our team gave him tools to deal with his physical injury along with moral injuries. He was given treatments, medicines and exercises to treat his neck and back pain. He was educated on how his anger and frustration were very normal and given relaxation techniques and plans for “health venting.”
When he left to go back to the battle, he was still bruised in body and spirit, but not broken. He was still prepared to give to his fellow Marines and to his family in the way that he so passionately desired. We are optimistic that this Marine sergeant will do well. Treating the battle-weary concussed warrior in theater will hopefully protect him from future emotional and physical disability.
It is our hope and prayer at the concussion center that by giving these heroes the help and tools they need we are treating not only their concussions or traumatic brain injuries, we are effectively treating their traumatic mind injuries.
Commander Earl Frantz is a sports medicine and family physician in the United States Navy, currently serving as the Officer in Charge or the Concussion Restoration Care Center, Camp Leatherneck, Afghanistan. Cmdr. Richard Sams Commander Richard Sams, the lead family practice physician at the C.R.C.C., helped to edit this blog post. The center is staffed by three physicians, a clinical psychologist, one physical therapist and an occupational therapist. Two Navy chaplains provide spiritual support.
The views expressed in this article are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the United States Government.