Traumatic Blast Injuries are the “signature wounds” of the Global War on Terrorism. Returning combat veterans may not know they have suffered such a wound, which is why it is so important for these new veterans and their families to have the information they need.

The National Institute of Neurological Disorders and Stroke (NINDS) says that Traumatic Blast Injury (TBI) (or “acquired brain injury”, “head injury”) occurs when a sudden trauma causes damage to the brain. Symptoms of a TBI can be mild, moderate, or severe, depending on the extent of the damage to the brain.

Understanding Traumatic Brain Injury

TBI can result when the head suddenly and violently hits an object, or when an object pierces the skull and enters brain tissue. If the head is hit or shaken, a “concussion” or “closed head injury” can result. Concussion is seldom life threatening, so doctors often use the term “mild” when the person only initially appears dazed or confused or loses consciousness for a short time. However, concussion can result in serious symptoms.

People who survive multiple concussions may have more serious problems.

The U.S. Centers for Disease Control and Prevention (CDC) notes the TBI can result from explosions and blast injuries. According to the CDC, “primary blast waves can cause concussions or mild traumatic brain injury (MTBI) without a direct blow to the head. Symptoms may include headache, fatigue, poor concentration, lethargy, depression, anxiety, insomnia, or other constitutional symptoms. The symptoms of concussion and post traumatic stress disorder can be similar.”

CDC also notes that bombs and explosions can cause unique patterns of injury. There are two categories of explosives, with both similar and differing health effects: High-order Explosives (HE); and Low-order Explosives (LE). The “blast wave” (a supersonic over-pressurization shock wave) is unique to HE and is different from the “blast wind” (forced super-heated air flow) produced by both HE and LE. Examples of HE that may be encountered by military personnel include TNT, C-4, Semtex, nitroglycerin, dynamite, and ammonium nitrate fuel oil (ANFO).

The impact of the HE blast wave with the body may result in blast lung (pulmonary barotrauma), TM rupture and middle ear damage, abdominal hemorrhage and perforation, Globe (eye) rupture, and concussion (TBI without physical signs of head injury). Additionally, individuals thrown by the blast wind or hit by blast debris may experience both closed and open brain injury.

Early symptoms of TBI can include being dazed or confused, "seeing stars," momentary or lengthy loss of consciousness, headaches, dizziness, blurred vision, pupil dilation, ringing in the ears, vomiting or nausea, convulsions, seizures, slurred speech, and inability to wake from sleep, among other polytrauma symptoms like loss of coordination, agitation, and weak or numb extremities.

Common Symptoms of Blast Injury “I just don’t feel like myself” Feeling light-headed or dizzy Difficulty organizing daily tasks Blurred vision or eyes tire easily Headaches or ringing in the ears Feeling sad, anxious or listless Easily irritated or angered Feeling tired all the time Trouble with memory, attention, or concentration More sensitive to sounds, lights or distractions Impaired decision making or problem solving Difficulty inhibiting behavior - impulsive Slowed thinking, moving, speaking or reading Easily confused, feeling easily overwhelmed Change in sleep - much more or much less Change in sexual interest or behavior

The Defense and Veterans Brain Injury Center (DVBIC) at Walter Reed Army Medical Center serves active duty military, their dependents and veterans with traumatic brain injury (TBI) through ensuring state-of-the-art medical care, innovative clinical research initiatives and educational programs.

• DVBIC Facts About Traumatic Brain Injury
• DVBIC 3 Question TBI Screening Tool
• DVBIC TBI Facts: Emergency Medical Services
• DVBIC TBI Facts: Vocational Rehabilitation and Employment Services
• DVBIC Facts About DVBIC
• Defense and Veterans Brain Injury Center (DVBIC) Brochure

Information from the U.S. Department of Veterans Affairs (VA):

• Research Volunteers Urgently Needed
  • VA-Madison seeking veteran volunteers for a research study on traumatic brain injury** [Information].
  • Other currently recruiting traumatic brain injury research studies and clinical trials: ClinicalTrials.Gov.
• VA TBI Quick Guide Patient/Family
• VA TBI Pocketcard Patient/Family
• VA TBI Quick Guide Physicans
• VA TBI Pocketcard Physicans
• VA Polytrauma Rehabilitation Centers Brochure (centers are located in Virginia, Florida, Minnesota, and California)
• VA Polytrauma Rehabilitation Family Education Manual

Information from the U.S. Department of Defense’s Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE):

• Outreach Center for Psychological Health and Traumatic Brain Injury Opens

Articles about service members’ experiences with TBI:

• "Veterans Battle Frustration" - The Press-Enterprise, October 2008
• "Mild Traumatic Brain Injury in U.S. Soldiers Returning from Iraq" – from the New England Journal of Medicine, January 2008
• “Traumatic Brain Injury in the War Zone” – from the New England Journal of Medicine, May 2005
• “A Shock Wave of Brain Injuries” – by Ronald Glasser, author of “Wounded: Vietnam to Iraq,” from the Washington Post, April 2007.

CDC:  Blast Injuries -- Fact Sheets for Professionals
In an instant, an explosion or blast can wreck havoc; producing numerous casualties with complex, technically challenging injuries not commonly seen after natural disasters such as floods or hurricanes. To address this issue, the U.S. Centers for Disease Control and Prevention (CDC), in collaboration with partners from the Terrorism Injuries Information, Dissemination, and Exchange Project, as well as other experts in the field, have developed fact sheets for health care providers that provide detailed information on the treatment of blast injuries.

Blast Injury Fact Sheets

• Blast Injuries: Essential Facts
• Injury Care: Prehospital
• Lung Injury: Prehospital Care
• Lung Injury
• Radiological Diagnosis
• Crush Injury and Crush Syndrome
• Post Exposure Prophylaxis for Bloodborne Pathogens
• Abdominal Injuries
• Extremity Injuries
• Ear Injuries
• Eye Injuries
• Thermal Injuries
• Pediatrics
• Older Adults
• Bombings and Mental Health

Additional Resources:

• America's Heroes At Work: TBI Symptoms and Treatment
• Invisible Wounds: Serving Service Members and Veterans with PTSD and TBI
• National Center for Injury Prevention and Control
• National Institute of Neurological Disorders and Stroke
• Return-to-College Program for Veterans with TBI