C Force: Shielding Against Brain Trauma Needs To Be a Societal Goal
I'm just guessing, but I imagine it would be hard to find a top expert in health or science who would not admit there's a lot we don't know about traumatic brain injury prevention and treatment. As defined by the Centers for Disease Control and Prevention, traumatic brain injury is any "disruption in the normal function of the brain that can be caused by a bump, blow, or jolt to the head, or penetrating head injury." Everyone is at risk for a traumatic brain injury, not just our military or athletes, especially children and older adults.
As for our military, support for this need to enhance our knowledge of traumatic brain injury most recently came in the form of a study conducted by Duke University. The study showed that under certain conditions, a helmet used by the French army in World War I provided better blast protection than the Advanced Combat Helmet widely used by the U.S. military. Researchers pointed out that, ever since the first modern combat helmet was introduced in 1915, these protective devices have been designed to protect heads not from invisible shock waves but from shrapnel, bullets and other blunt physical objects.
It is also noted that it was only when modern helmets were exposed to overhead blast waves that the 1915-era helmet outperformed them. The Duke researchers point to the raised metal crest running from the front to the back of what was known as the Adrian helmet (similar to a design feature also found on helmets used at the time by French firefighters) that may explain its superior protection from overhead blasts.
"The geometry of the helmet can make a big difference," Joost Op 't Eynde, a Belgian bioengineering doctoral candidate at Duke who led the research project tells NPR. "... Just being aware of how the geometry might affect the way that the head and the brain might experience a shock wave is definitely something that I think should be kept in mind in (military) helmet design."
A separate 2014 review conducted by a committee created by the National Research Council notes that while the Kevlar-based Advanced Combat Helmet has evolved from its World War I predecessors, the principal approach to helmet design is still protection from striking objects. Lt. Col. Ginger Whitehead, the product manager for the Army's protective equipment, told Military.com in 2019 that she believes a research gap may account for delays in progress in designing a blast wave-resistant combat helmet. "It goes back to the medical community not establishing a correlation of injury to the blast wave," she says. As pointed out back in the 2014 National Research Council report, "The level of protection from nonfatal brain tissue injuries ... (and the) health consequences beyond the acute phase, is not known."
Retired Gen. Peter Chiarelli, former vice chief of staff of the Army, has devoted much of his time since leaving active duty in 2012 advocating a better understanding of traumatic brain injury. "We've spent billions of dollars -- I did, as vice chief of staff -- researching traumatic brain injury and post-traumatic stress, and we really haven't gotten much return on that investment," he tells NPR. "And I would argue it's not necessarily the money that makes the most impact; it's groups of researchers that are willing to work together, share data, learn from each other."
University of Rochester physicist Eric Blackman, who co-authored a 2007 study examining the need for better traumatic brain injury protection in combat helmets, believes a combat helmet that better protects against traumatic brain injury is both necessary and possible. "There needs to be some kind of prioritization with very specific goals," he says, suggesting something akin to the Manhattan Project during World War II.
It must also be pointed out that in March 2019, the U.S. Army equipment officials announced the fielding of a new combat helmet designed to give soldiers 100% greater protection against blunt impact. At the time, the next-generation helmet was being fielded only to close-combat units. It is said to double the amount of protection against blunt impact or trauma to a soldier's head compared with its predecessor. It is not clear how effective or widely used within the war zone this helmet is.
The Journal of Military and Veterans' Health is a respected clinical publication dedicated to advancing the health and well-being of, and the provision of medical and health care support to, men and women serving in the military and after their military careers.
The scope of the journal recognizes that military and veteran health matters extend across the whole life span of the member -- from the time they join the military through periods of active operational or nonoperational service, including time within the reserve forces, to post-military service and into retirement and old age.
Blast-related mild traumatic brain injury has been called the "signature injury" of the wars in Iraq and Afghanistan. In a recent report, the journal points out that diagnosis of concussion or mild traumatic brain injury continues to remain clinically challenging and that "neurological examination and cognitive symptoms may not accurately map the nature and severity of underlying brain injury."
While 100% protection may not be possible against blast waves, the superior performance of a century-old combat helmet should be a reminder that there is ample room for improvement in protecting the health of men and women serving in the military, as well as after their military careers have ended.
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