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In Iraq, a head wound isn't always a trip home

U.S. soldiers and Marines in Iraq often are pressured to return quickly to duty, writes NBC's Robert Bazell. Could that lead to an epidemic of mental health issues among veterans in years to come?
/ Source: NBC News

When I arrived in Iraq recently I had a question for the leaders of the medical staff.

Last year when I was reporting on the treatment of brain injuries among troops returning from the war, I learned many experts were concerned about low-level brain injuries among the troops. The rehabilitation experts at Veterans Affairs had been shocked to hear that soldiers and Marines who had been exposed to the concussive force of numerous blasts from roadside bombs, but not obviously injured, were routinely returned to duty.

The VA experts worried that this could lead to an epidemic of mental health issues among veterans in the years to come. I asked at the Pentagon if anyone was concerned about the issue and got no answer.

In Iraq, I found that what the VA experts were hearing is certainly true. Improvised Explosive Devices (IEDs) remain the signature weapon of this war. These bombs have gotten increasingly powerful.

In the military hospitals in Iraq, most of the U.S. wounded had been injured by IEDs. Most surprising to me, it was not the first IED for most of them. In fact, I met several who had survived as many as five IED blasts. One young soldier had been through five in the past six weeks alone.

The explosions often fracture limbs severely. Even with the best body armor the concussive force can smash internal organs. Troops with obvious injuries receive immediate treatment and a fast trip home for rehabilitation.

What if the soldier just passes out for a few minutes or an hour? That often happens when the brain is shaken against the skull, and stops working temporarily.

Detecting 'subtle' damage
Right now, the procedure calls for the soldier to be checked out for a day at most and returned to duty. 

“Most of the pressure comes from the soldiers to go back to duty,” Dr. Phillip Cuenca, an Army anesthesiologist who is interested in the issue, told me. “The commander has to meet the mission, so if that soldier can still walk and carry out orders and is physically able, it is certainly reasonable for him or her to return to duty.”

Col. Alan Bruns, a surgical consultant, told me that the military remains concerned about subtle brain damage from explosions. New practice guidelines were recently issued for doctors in the field to recognize tiny neurological changes in the troops.

“We want safety, not only for our soldiers who have experience with IEDs, but for their peers as well,” Bruns said. “It doesn’t help their peers to have a comrade come back who has been sort of dazed by an IED. We want to make sure they’re taken care of properly.”

Cuenca and many others point out that more research is necessary to find ways to detect these subtle neurological signs that can be difficult to differentiate from fatigue, stress or headache that you or I might feel.

Any long-term effects on tens of thousands of veterans of this war will, of course, take years to discover. Many experts, including those at the VA, worry they could be widespread.