by Derek Farwell
Columnist

One of the things that all soldiers who go into combat know is that there is a very real possibility of being killed or suffering from some devastating physical injuries. Anyone who has been in combat has probably seen it before, and it can be an extremely ugly sight. Throughout American history we’ve been involved in many wars and conflicts, each different in its own way as they were fought under different circumstances and against different enemies that use different tactics. From the conflicts in Iraq and Afghanistan has come an emphasis on brain injuries. I don’t think it’s because brain injuries are more common now than they were in other wars, but medical technology has improved enough that more is now understood about the brain. I am by no means doctor of neurology or an expert on traumatic brain injury (TBI), but I’ve learned a bit about since I sustained one during my deployment.

It sounds pretty simple, you get hit in the head, you get a concussion, but many people who sustain a TBI are not otherwise physically injured from the explosion, but being at the epicenter of an explosion actually can cause a number of different injuries, whether they be seen or unseen injuries. Some people can be grievously injured from an explosion while others can be mostly unscathed but still die from being near an explosion. In my particular case I sustained a few of the different possible injuries. I’m not entirely sure what happened as I was knocked unconscious. I was hit by shrapnel which caused a number of lacerations, hit in the head by blunt force trauma from some object that was harder than my head, and I was exposed to the blast wave.

Most people associate blast injuries with gruesome shrapnel wounds. Shrapnel is typically splinters of metal that are ripped apart from the bomb casing, or any other debris that is thrown off by the explosion such as rocks or glass. Shrapnel wounds are typically very ugly because it is usually jagged pieces that rip and tear through the body and shred anything in its path. Shrapnel is strange, and it doesn’t take a set path. You can be standing somewhat close to an explosion and not be hit by shrapnel by pure luck, or you can be standing a distance from it and hit by one small piece of shrapnel that hits the right spot and kills you. Blunt force trauma is caused when a person is thrown into some stationary object that the head smashes into and causes the brain to slam into the inside of the skull which can cause a concussion and potentially swelling of the brain.

The lesser known but equally destructive force is the effects and the damage caused by the blast wave of an explosion. When a bomb explodes it releases an incredible amount of outward energy that travels in the direction of least resistance. It also sends out a blast wave. Essentially the explosion compresses the air and sends out a wave of high pressure that is far greater than the human body is meant to withstand. This wave of high pressure can have devastating consequences on the internal organs of a person, especially the organs that are filled with air or surrounded by fluids, such as the brain or the lungs. The effects are similar to ‘the bends’ that scuba divers experience if they ascend too quickly from a high pressure area to a low pressure area. Once again, I’m not a doctor so there is much more to this, but this is my basic understanding of how it works.

TBI is unique in that it tends to manifest itself differently in different people. It can affect people’s physical, mental, or cognitive well-being. There is a lot that is still not known about the long term effects it can have on people. I do know however that it is something that you can get help for if you have experienced it. The first step is identifying that you have it so if you’ve ever been near a large explosion or suffered blunt force trauma during your military service then you should get checked out at your nearest VA Medical Center.

drfarwell@hotmail.com