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Traumatic brain injury is the signature injury of the wars in Iraq and Afghanistan, and many soldiers suffer in silence. New treatment can heal the wound.
Fort Bragg, NC — Four and a half months into his stint in Afghanistan as a Special Forces medic, Karl Holt had a hand in saving life and comforting the dying.
He treated a local man, carried in lying on a sheet of plywood atop a wheelbarrow, so mangled by an explosion that the then-32-year-old medic from Houston couldn’t tell bits of bone apart from gobs of flesh. Holt wrapped the man in blankets for warmth as he died.
When a homemade bomb ripped through a convoy, Holt helped get an IV into a wounded soldier and had him evacuated so fast that he survived despite suffering burns over 92 percent of his body.
Not every mission was so gruesome: One night raid ended with a dog bite as the only injury.
In up to five missions a week, Holt learned one truth about the Taliban: What they want most is to brag about the Americans they have killed.
That fact kept Holt alert while securing the perimeter during another night raid on Oct. 26, 2009. Holt cordoned off his area for hours while other members of his team assaulted a compound in northern Afghanistan that housed traffickers in drugs and weapons. At one point, an RPG round flew by Holt so close that the blast of air knocked him to the ground.
At about 3:30 in the morning, the sounds from a pair of Chinook helicopters pierced the air. It was time for the Special Forces unit to go.
Thick smoke and flames from the firefight covered the scene. Even the soldiers wearing night vision goggles couldn’t see the helicopters.
Holt guided himself by the whoosh of the rotor blades. He knew he was close when the wind whipped by the Chinooks slapped sand into his face.
Enemy fire poured into the landing zone as Holt boarded one of the helicopters. The pilot took off.
Holt knew mountains loomed in the darkness and confusion. Seconds before slamming into a high cliff the pilot pulled up on the controls. The Chinook, angled nearly 90 degrees, lost power and began to fall.
Crashing into a two-story compound, the helicopter broke into two pieces. Holt blacked out.
When he awoke Holt found himself buried under a mountain of equipment. His first thought: I am alive. His second thought: I can’t breathe.
He forced out a lungful of air, spitting out most of his upper front teeth along with his desperate breath.
Lost teeth were the least of his worries. With the crash’s flames bearing down, Holt threw off the equipment that had him pinned. He soon realized that part of what he had to remove included body parts of the dead.
He didn’t have time to consider the gruesome scene. The heat inside the helicopter cooked off round after round of ammunition, which began to pop and crack.
Holt crumpled to the ground when he tried to stand. It was crawl or die.
He dragged himself toward the screams of those outside who were begging for the rest to escape.
Holt was the next to last soldier to make it out alive. Ten Americans died. With 16 wounded soldiers, Holt was the only medic on the ground. But he had his own injuries: a shattered top jaw, a broken back, two dislocated shoulders, a fractured left leg, and ruptured left ankle tendons.
Holt’s war in Afghanistan had ended. But a new battle had just begun. It was one that would rage long after his ruptures, fractures, broken bones, and dislocations had healed.
When he lost consciousness on the helicopter, Holt suffered a Traumatic Brain Injury (TBI) that, remaining untreated for nearly two years, continued to fester. It transformed Holt from a soldier who kicked in doors in Afghanistan to a man who had to put sticky notes on the door of his North Carolina home reminding him to lock it before leaving.
Military doctors are calling TBI the signature injury of the wars in Iraq and Afghanistan. Between 2000 and Aug. 20, 2012, there have been 253,330 reported cases of TBI among all members of the Armed Forces, according to the military’s Defense and Veterans Brain Injury Center. Of that number 147,536 have occurred in the Army.
Concussions are a form of TBI. But these are concussions delivered by hits more jarring than those that come from a charging 230-pound NFL linebacker.
As with Holt, accidents and crashes occurring in the pressure cooker of the battlefield (or in training on a stateside military base) can cause a TBI injury. Improvised explosive devices, or IEDs, the weapon of choice for insurgents fighting U.S. forces, have caused many of the military’s combat TBI cases.
More soldiers are coming home with TBI symptoms simply because more soldiers are surviving other wounds that would have killed them in previous wars. Soldiers whose heads got rocked by an explosion along the beaches of Normandy or the jungles of Saipan during World War II or inside the tunnels of the Viet Cong during the Vietnam War probably died from visible physical wounds long before doctors had a chance to discover the aftereffects of the blasts on the soldiers’ brains.
But improved protective gear, advancements in medical technology, and a triage system that yanks severely wounded soldiers out of the battlefields and into military hospitals in Germany and the United States have given military doctors thousands of new patients who are experiencing the consequences of rattled brains.
These invisible wounds often go undetected, and they are hard to explain to patients and their families.
If a brain is like a city where information travels along roads from building to building, then TBI unleashes an earthquake on that city. Usually it’s the type of earthquake that doesn’t knock down the buildings. But it damages the roads enough to disrupt the way the brain communicates. In extreme TBI cases, even the buildings are knocked down, crippling the patient’s mental capacity.
TBI cases are divided into subcategories. Doctors have classified about 77 percent of the military’s TBI cases as mild, including Holt’s injury. Nearly 17 percent of cases have been labeled moderate, while just 1 percent of cases have been diagnosed as severe. The classifications depend on the length of unconsciousness, disorientation, and memory loss.
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