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U.S. Army treats brain injuries in the field
By Kristin M. Hall
BAGRAM AIR FIELD, Afghanistan -- The traumatic brain injury that Army Staff Sgt. Isidoro Castillo suffered when a suicide bomber attacked his unit in Afghanistan could have meant the end of his deployment.
Instead, Castillo's doctors handled his injury without sending him back to the United States, part of a military effort to better treat and track brain injuries that have become a signature affliction of the war.
Castillo, originally from Fayetteville, N.C., described the bombing days later while he was recovering in a new specialized housing unit for soldiers being treated for brain injuries.
"He was in my peripheral vision. I heard a pop and I hit the ground and the explosion went off," Castillo said. Five soldiers from his 18-member mentoring team were killed during an April meeting with Afghan soldiers at an outpost in the eastern province of Nangarhar.
The Army has had to rethink the way it deals with traumatic brain injury in Afghanistan and Iraq because U.S. soldiers often are targeted by roadside or suicide bombs. Not treating the sometimes hard-to-spot injury can lead to physical and emotional problems that linger long after the soldier returns home. But sending troops out of country for treatment can leave battle units short-handed.
Medical evacuations from combat zones for traumatic brain injury have been growing, from 194 in 2008 to 303 in 2010, according to statistics provided to The Associated Press from the Armed Forces Health Surveillance Center. Last year, the military implemented a strict new policy on treating and tracking soldiers with concussions right on the front lines of war.
Medical officers in Afghanistan say the new approach, which required opening seven new rehabilitation centers called Level II clinics throughout Afghanistan, is allowing more soldiers to go back to their units rather than be evacuated for treatment. Soldiers who are sent home for treatment generally don't come back.
Castillo was treated under the new guidelines. After diagnosis in the field, he was sent to the rehabilitation clinic the 101st Airborne Division set up at Bagram Air Field for about a week before returning to his unit.
On the hot and dusty military base, Castillo had his own room in a cool, quiet housing unit near the hospital, where he could watch movies on a flat-screen TV, play video games or toss a volleyball around on the sandy court outside. Medical crews use these leisure activities combined with military fitness tests, such as running with body armor or maneuvering around obstacles, to determine whether the soldier is fit to return to duty.
The clinics are also stocked with card games and Wii video games, which help occupational therapists look for memory loss or balance issues.
Castillo and other soldier patients meet daily with doctors and have dedicated occupational therapists who monitor symptoms like concentration, balance, headaches and dizziness. The care they are receiving in Afghanistan is similar to TBI rehabilitation programs at military hospitals in the U.S.
"It makes you feel like the stress is gone," Castillo said. "You have nothing to think about but how am I going to get better, what's my next appointment. They just let you breathe."
Clinics that opened last year in eastern Afghanistan returned about 1,000 soldiers to their units, said Maj. Kevin Ridderhoff, the pharmacist for the 101st Airborne Division who oversaw the program during the division's deployment. Ridderhoff said about 97 percent of soldiers who were referred to a Level II clinic were returned to duty after an average three-day stay.
"A big thing is eight hours of uninterrupted rest. Sleep is the goal," Ridderhoff explained. "With concussion, most of these guys get better. That's a good thing."
One of the final assessments is a military performance test. The soldiers don their body armor, go on a road march or a run, maneuver around obstacles, jump in and out of vehicles _ all normal activities for active duty. If a soldier is able to complete them without problems or recurring symptoms, the occupational therapist can recommend a return to their unit.
The 101st Airborne Division, which sent 24,000 soldiers to Afghanistan over the past year, has been at the forefront of the new care regimen for what's called mild traumatic brain injury, often called concussion. It trained all unit medics on symptoms and brought the occupational therapists to Fort Campbell for additional training before opening the Afghanistan clinics.
The policy says soldiers are to be given at least 24 hours rest after the first concussion, seven days of rest after the second concussion and an in-depth neurological exam after the third. The policy also directs medics to check for signs of a concussion after key events, such as if a soldier is near a blast, is in a vehicle rollover accident or has a direct blow to the head.
The soldiers recovering at Bagram are separated from their units, but they could still bond with other injured troops over their near-death experiences.
Photos get passed around of a pile of charred, twisted metal _ all that's left of the armored vehicle that Pfc. Kyle Kinmartin was in when it rolled over a pressure plate armed with homemade explosives. Kinmartin said he was still having trouble sleeping because he kept thinking about the explosion and fire that could have killed him or his buddies.
"I don't feel like I got blown up, but my body feels it," he said. "I just want to get back and see the guys."
Capt. Barbara Drawbaugh, an occupational therapist who worked at the mTBI center at Forward Operating Base Fenty in Jalalabad, said they are not pushing injured soldiers back into the fight if they aren't ready. "It's not so much that we are trying to force them back out there. It's that we are providing a really good environment of care to allow them to heal," she said.
Soldiers are at risk of more severe and enduring symptoms if they are not allowed to heal after a concussion and suffer a second one too quickly, Drawbaugh said.
But not all soldiers return to their units after a brain injury if more specialized care is needed.
Spc. Matthew Wright, a military policeman, spent weeks at Bagram and watched other soldiers get better and return to their units, but his symptoms weren't improving. Wright had stepped on a hastily planted bomb and got the brunt of the force of the explosion, but the shrapnel went into the ground instead of his body.
Eventually he was medically evacuated back to Fort Knox, Ky., to get further treatment in a Warrior Transition Unit. He hopes he can return to his job soon.
"It's nice to see they are taking this brain thing seriously," he said.
Feeling a sense of obligation to the mission, Castillo returned to the base where his unit was attacked. He still deals with symptoms, like headaches and feelings of anger. But the 40-year-old non-commissioned officer who has had three previous deployments said he's learned not to ignore the real consequences of a concussion.
"Don't fake the funk. If you're not real and let it out, then you're not going to heal properly and it will cost you in the future," Castillo said.