The US Army Aeromedical Research Laboratory tested the same shock-absorbing pad systems for the ability to decrease non-ballistic impact forces in parachutists' helmets. The helmet upgrade kit reduced impact loading by over 28%. See: USAARL report 2005-05 of March, 2005. and the latest report: PASGT/ACH comparison

4-28-2009: See Doc Bob's Blog for the latest info on brain injury in Iraq and Afghanistan by clicking Here

Head Injuries Push Improvements In Gear
By Sandra Jontz
Stars and Stripes
European Edition

January 30, 2004

WASHINGTON — U.S. troops are suffering traumatic brain injuries in greater numbers in Iraq and Afghanistan than in previous wars, prompting studies on better helmets and improved medical treatment and recuperation care.

An area of scientific focus at the Defense and Veterans Brain Injury Center, headquartered at Walter Reed Army Medical Center in Washington, D.C., is how many traumatic brain injuries, or TBI, are direct results from the shock wave of a blast, and not just from the head impacting with the ground or other head and brain injuries wounds caused by shrapnel, for example, said Laurie Ryan, the center's assistant director for research.

In a preliminary study done among troops treated at Walter Reed, scientists analyzed 155 patients wounded in combat in Iraq to see if any showed signs of combat traumatic brain injury. Of the 155 troops, 96, or 62 percent, showed symptoms of minor to severe brain injuries. Of the 96, 88 likely had sustained an injury as a result of a blast, such as an explosion from a landmine, rocket propelled grenade or improvised explosive device, she said...  [Full Article]

Newsweek, Mar 20, 2006, page 37n  [full article]


Brain Injury in the War Zone
By Susan Okie, M.D.

[Full Article]

... A blast creates a sudden increase in air pressure by heating and accelerating air molecules and, immediately thereafter, a sudden decrease in pressure that produces intense wind. These rapid pressure shifts can injure the brain directly, producing concussion or contusion. Air emboli can also form in blood vessels and travel to the brain, causing cerebral infarcts. In addition, blast waves and wind can propel fragments, bodies, or even vehicles with considerable force, causing head injuries by any of these mechanisms. Approximately 8 to 25 percent of persons with blast-related injuries die...

Most adults with a mild TBI (Traumatic Brain Injury) recover completely within a year, but moderate and severe TBIs are more likely to cause lingering effects. An estimated 5.3 million Americans are living with disabilities that resulted from TBIs, according to the Centers for Disease Control and Prevention. Warden said many patients with such injuries who are treated at Walter Reed are able to return to active duty; others retire from the military and receive medical disability payments. The Department of Veterans Affairs is now planning for the large influx of veterans with TBIs from the current conflicts who will need continuing care during the coming years. "These are people who are going back into our communities all across the country, who are potentially going to be struggling," said Warden. "Keep in mind, these patients, because of the nature of their brain injuries, can be the ones at highest risk of falling through the cracks." ...

Other great information is available at the Brain Injury Resource Foundation


"Many of these injuries could be prevented or reduced with the use of cushioned helmets which are now only available to a fraction of the U.S. troops. Everything possible should be done to acknowledge the severity of combat injuries and ensure that brain injury is detected and treated now, and throughout these veterans' lifetimes. "

USA Today June 8, 2006 Pg. 13
Pentagon Holds Brain Injury Data
By Gregg Zoroya, USA Today
The Pentagon is refusing to release data on how many soldiers have suffered brain injuries in Iraq and Afghanistan. It says disclosing the results would put the lives of those fighting at risk.

The data come from screenings of 1,587 soldiers at Fort Bragg in North Carolina and 9,000 at Fort Carson in Colorado. Army Medical Command spokesman Jaime Cavazos said Wednesday that the results of the tests represent “information the enemy could use to potentially make soldiers more vulnerable to harm.” He declined to elaborate.

Pentagon scientists and other health officials have made public similar data from other installations. Those results show that about 10% of combat troops and 20% in front-line infantry units suffered concussions during their tours. The injuries frequently go undiagnosed; multiple concussions can lead to permanent brain damage.

The screening is done with a questionnaire prepared by the Defense and Veterans Brain Injury Center, a research arm of the Defense and Veterans Affairs departments. The questionnaire is used at four military bases, and center director Deborah Warden has urged that it be used throughout the military. The Pentagon has declined to do so because it questions whether troops can accurately answer the questions in the screening.

Naval Medical Center San Diego, which has been screening Marines from nearby Camp Pendleton for two years and, more recently, soldiers from the Army's Fort Irwin released data this week.

Those data show that 10% of 7,909 Marines with the 1st Marine Division suffered brain injuries. Researchers tried to follow up with 500 Marines who suffered concussions. They reached 161 of them and found that 83% were still suffering symptoms on average 10 months after the injury.

At Fort Irwin, 1,490 soldiers were screened, and almost 12% suffered concussions during their combat tours.  (ed: doesn't rate "classified" , as US media reports the same issue over and over)

Army scientists at Fort Rucker, Ala., developed, and the U.S. Soldiers Systems Command at Natick, Mass., tested the new Advanced Combat Helmet, an improvement over both the special forces' Modular Integrated Communications Helmet, or MICH, and the current Kevlar helmet.

"The Kevlar is great against penetration injuries [such as from a bullet or shrapnel], but doesn't provide much protection … from concussion injuries because it is not well-padded," Ryan said...

Note: The lifetime cost to care for a brain-damaged military person is between 2.5-3.5 million dollars, not counting the pain and suffering of the trooper and his/her family. That amount of money would buy a LOT of helmet upgrade kits!.

For full article, click here

Another reference: Schootman M, Buchman TG, Lewis LM.National estimates of hospitalization charges for the acute care of traumatic brain injuries.Brain Inj. 2003 Nov;17(11):983-90


It is interesting to hear from the troops on the front lines in Iraq that they prefer to install their BLSS upgrade kits in the new, more 'bullet-proof' Marine helmet. The strap suspension system in the new helmet makes it  just as uncomfortable for prolonged wear as the old "kevlar". So, bless their inventive souls, they take the upgrade pad kit out of their old kevlar and put in the new LWh helmet or ask us to send them another one. We do so gladly!  Anything that will encourage the troops to wear their helmets longer and perform their tasks better and more safely is a goal worth striving for.  Commanders want their troops to fight smarter, not just harder!

This article refers to the older PASGT helmet, now superseded in the Marines by the LWH and Army by the ACH/MICH

Brain injuries high among Iraq casualties

By Spc. Chuck Wagner

WASHINGTON (Army News Service, Nov. 24, 2003) -- U.S. casualties in Iraq may be suffering a greater share of brain injuries than in previous wars, causing concern among military doctors.

Doctors with the Defense and Veterans Brain Injury Center at Walter Reed Army Medical Center say early casualty assessments suggest service members are returning with a wide range of brain injuries — from mild concussions to coma or death — in larger percentages than the military's rule of thumb.

This suspected rise in an injury notoriously debilitating to victims and hard for doctors to diagnose may result from the terrorists' explosive arsenal and vulnerabilities in current U.S. combat gear, according to experts.

"It's always been well known there are going to be brain injuries in combat," said Dr. Louis French, a neuropsychologist and assistant director for clinical services at the brain center. "About 20 percent is usually what's talked about. So far, what we've seen suggests a higher percentage."

Among 105 casualties assessed between June and October, doctors discovered about two-thirds, or 67 percent, to have brain injuries, according to Dr. Laurie Ryan, another neuropsychologist and the assistant director for research.

The center is pursuing several studies to statistically verify the trend.

The cause for the dramatic increase seems to be the changed nature of warfare in Iraq. The terrorists' weapons of choice are high explosives. Land mines, rocket propelled grenades and improvised bombs allow terrorists to skirt direct engagement with better trained and equipped soldiers, and can still inflict damage to soldiers whose torso, or in military jargon their "center mass", is protected against small arms ballistics.

"There's not as many gunshot wounds," French bluntly noted.

Ironically, a well-protected body has forced the enemy to attack the brain, the only organ still vulnerable to deadly attack.

Another leading cause of head injuries is vehicle accidents, said Ryan, followed by falls.

Although soldiers are wearing head protection, the Kevlar helmet may not be serving soldiers as a solid defense against modern warfare's growing threat - concussive impact.

"It's like a pan on your head, held on by shoestring webbing," said Sgt. Tyler Hall of the 14th Combat Engineers, Fort Lewis Washington. "The Kevlar is a crude system. When you take a hit, it rings your head like a bell.The Kevlar physically moves and bounces on your head. It's heavy and you hear soldiers complaining about headaches a lot," said Hall, running his hand along the back of his head, still laced with metal sutures. "I'd like to see the Army find something better."

"It's not designed to absorb impact," French concurred.

The center's doctors also are involved in analyzing the newly developed Modular Integrated Communication Helmet (MICH) for its protection against impact-related injuries, said Ryan.

The MICH is currently fielded with Rangers, Special Forces, Navy SEALS, Air Force Special Operations, the Marine reconnaissance community, the FBI's Hostage Response Team, and a brigade at the 82nd Airborne Division, according to a MICH project officer.

The padded MICH is the only ballistic helmet used by Special Operations Command also authorized for use with motorcycles or other all-terrain vehicles, which the project says attests to improved impact protection. Lab testing showed a 40 percent improvement in impact protection over the Kevlar.
(Editor’s note: Spc. Chuck Wagner writes for the Pentagram newspaper at Fort Myer, Va.)

Doctors Seeing More Brain Injuries From Iraq: Defense and Veterans Brain Injury Center at Walter Reed: excerpt

"Protective Gear May Be Contributing to Rate Higher Than in Previous Wars".

One factor, doctors say, could be the nature of the war in Iraq. Many of the injuries to U.S. troops are caused by improvised explosive devices and rocket-propelled grenades -- weapons that are more likely to cause brain trauma than a bullet.
     "Certainly we have seen a high percentage of blast-related injuries," said Laurie Ryan, a neuropsychologist with the center. "Given this, we may well end up seeing a higher number of brain injuries."
     Moreover, doctors at Walter Reed suspect that the Interceptor body armor that has saved the lives of many soldiers in Iraq has meant that there are more survivors with injuries to the head, wh ich is less protected than the torso. Ironically, the protection afforded the torso has left the brain as the most vulnerable organ, particularly to concussive impact.
     The brain injury center is helping analyze whether a new helmet being worn by some U.S. troops is better suited for protecting soldiers from concussive impact than the standard Kevlar helmet (PASGT) most soldiers and Marines wear. The new Modular Integrated Communication Helmet includes a padded suspension system, but it is worn only by Army Rangers, various special operations forces, Marine reconnaissance units and some Army paratroopers.
     The helmets worn by most troops "are great at stopping flying shrapnel," said French, but soldiers complain that they are not designed for absorbing concussive impact. "It's like having a pot on your head," said Army Staff Sgt. Tyler Hall, a Walter Reed patient who suffered serious brain trauma and other injuries from a booby-trap explosive.

A very informative site from the Defense and Veterans Brain Injury Center describes How Blast Forces Cause Brain Injury. A MUST READ. Some what outdated, as they cite 50% of injuries caused by blasts. The figure as of August, 2005 has risen to over 65% and in 2009 to over 75%.

(Christian Science Monitor, December 13, 2005, Pg. 20)
Tuesday marks the 1,000th day of the war in Iraq. Apart from the debate over its purpose and progress, here are some basic facts about the conflict.
--2,149 US forces have been killed, including 44 women.
--15,880 US soldiers have been wounded.
--Of the 2,149 US troop casualties, the largest number resulted from hostile fire (some 693). Other major contributors: Improvised Explosive Devices (636); accidents, friendly fire, and other nonhostile causes (393); helicopter losses (126); car bombs (111).


Short Medical Piece on mechanism of blast injury: This piece discusses the three mechanisms of injury from blasts, mainly related to 9/11, but applicable to all blast forces.