Mild traumatic brain injury and the military

Military service members are at an increased risk for sustaining a mild traumatic brain injury (mTBI), or concussion, compared to the general population.

Young men between the ages of 18 and 24 are considered most at risk for traumatic brain injury (TBI). More than 400,000 members of U.S. armed forces were diagnosed with a first-time TBI between 2000-2019, and more than 80 percent of these first-time injuries were classified as concussions, according to the Traumatic Brain Injury Center of Excellence (TBICoE).

Most concussions in the military occur outside of battle, and over 30 percent of military brain injuries are due to motor vehicle accidents. Service members who are stateside are also at risk for TBI due to regular occupational requirements, including training exercises, field operations, convoy operations, and physical fitness requirements.

Causes

Leading causes of TBI specific to the military include:

• Blasts from improvised explosive devices, suicide bombers, land mines, mortars, and rocket-propelled grenades
• Motor vehicle crashes
• Hand to hand combat and combat training
• Bullets or shrapnel
• Hard, whole-body impacts including parachute landings
• Falls, especially from equipment and/or vehicles
• Sports and recreation activities
• Boating injuries
• Barotrauma injuries caused by pressure changes, as can occur in divers, or in pilots from quick changes in altitude
• Other occupational duties and hazards

Blast injuries

Mild TBI has been a prevalent injury in recent conflicts, and the primary cause has been blast injuries. This specific kind of traumatic brain injury can occur when someone is exposed to an explosive device, such as an improvised explosive device (IED). The resulting brain injury tends to be mild and is often called a concussion.

• First level: High-pressured shock waves that impact brain. The waves cause energy pulses inside the body that result in unnatural brain movement and stretching.
• Second level: Projectiles or shrapnel from an explosion that can hit or penetrate the brain
• Third level: Hitting the head on the ground or object due to being thrown by the blast wind. This makes the soft brain move around in the hard skull.
• Fourth level: Burns, lack of oxygen to the brain, breathing in toxic chemicals

Working with military populations

The military population has unique healthcare needs. Providers and clinicians can assist these individuals with culturally competent care that extends not only to the service member being served, but also to members of their support system.

Fewer than half of the veterans enrolled in the Veterans Health Administration (VA) accessed its services in 2017. Veterans who do utilize VA services also frequently receive care in the civilian community, as military populations increasingly seek services from medical providers within the civilian sector. These numbers may also increase due to changes to veteran care access to civilian providers through the MISSION Act (2019).

Understanding and knowledge in the following areas can help medical providers provide the optimum level of care:

• Identification of veterans who are accessing services
• Obtaining a military health history
• Impact on families and support systems of military service members
• Knowledge of specific methods of injury and likely impact on function
• Common challenges facing military populations including integration back into civilian life
• Understanding of military history, structure, and lingo
• Awareness of barriers to medical care and resources to address these challenges
• Knowing what to say and what not to say when providing care