“Wounds of War III: Coping with Blast-related Traumatic Brain Injury in Returning Troops”

On behalf of the Austrian Peacekeepers and the Austrian Ministry of Defense, I want to welcome each of you and extend a special welcome to our distinguished guests who we look forward to hearing from today.

Austria first engaged in peacekeeping operations in the Congo in 1960. In the last 50 years more than 90,000 Austrian soldiers have taken part in peacekeeping operations, amongst them also a large portion of reserve soldiers. In 1995 a veteran organisation of military and civilian peacekeepers was founded. As President of this association I have been involved with the problems of traumatic injuries quite recently. The Austrian Peacekeepers organize the Blue Helmet Forum Austria every year. In 2010 the topic of the Forum was “Stress Management and Peacesoldiering.” On this occasion I had the pleasure to meet some of you. I must say I was extremely impressed by the high professional standard of the presentations and the lively discussions. I admit that as an ordinary soldier I sometimes felt that I had difficulties following the subject matter, but I realized the enormous importance of your expertise for the operational effectiveness of our troops and for the personal wellbeing of our soldiers.

By coincidence, the NATO sponsored Advanced Research Workshop held in Austria last year dealt also with Posttraumatic Stress Disorder. This time you will be discussing the effects of Traumatic Brain Injury and ongoing efforts to address the devastating impact of these injuries. Thanks to the sponsors of the workshop and to organizers Professor Brenda Wiederhold and Professor Walter Mauritz it has been possible to gather again a group of distinguished experts.

I believe these workshops are important because it is imperative that we continue to work together towards better and more effective strategies to both prevent and treat Traumatic Brain Injury. In the kind of asymmetric warfare we now have to face we must recognize the fact that Traumatic Brain Injuries will be a growing reality.

Dr. Norman Vincent Peale, an American minister and forefather of the power of positive thinking, once said, “When every physical and mental resource is focused, one's power to solve a problem multiplies tremendously.” I could not agree more with Dr. Peale and I also believe that working collaboratively, we can share insights, accelerate discoveries, and more effectively prevent and treat Traumatic Brain Injuries. We have incredible resources here with us over the next three days, and I encourage each of you to recognize the potential outcomes of your interactions, lectures, and discussions. Your ideas, intelligence, commitment and devotion to solving these complex problems may directly save lives of our military service men and women and will help to offer hope for their families and friends.

I am sure we can discover the right answers and our efforts should be, and I believe will be, focused on finding them … together.

Today, blast injuries are the most common injury treated in the Iraq and Afghanistan theaters. In 2006, almost 22% of all injuries treated were Traumatic Brain Injuries. At the time, that number was an estimate and many injuries from blasts were not categorized as Traumatic Brain Injuries but instead considered mere headaches, mood disorders or other “head and neck wounds.” What is clear today is that these numbers were vastly underestimated. Why?

We know now there was a lack of ability to promptly and accurately diagnose such injuries. If someone is missing a limb, we know immediately it is serious and the treatment that must be followed is known. A brain injury is not as apparent. We have seen many cases in which a team of soldiers riding in a Humvee encounters a roadside bomb. These soldiers, after being slammed against the heavy armor of the vehicle, appear mostly unscathed and seemingly capable of returning to duty.

We know now that many of these soldiers who lack any outward sign may very well have suffered a Traumatic Brain Injury. It is likely that tens of thousands of our combat men and women are misdiagnosed, ignored, or dismissed completely.

We need, therefore, to pay more attention to education. Not long ago leaders in the field did not know of the effects of Traumatic Brain Injury and were wholly ill equipped to make such judgments. They did not know what to look for, how to detect Traumatic Brain Injury and most importantly, how to prevent and treat it. But times are changing and through education and vigilance, field commanders, doctors, and other staff can no longer ignore the effects of such injuries. These are injuries that MUST not go undiagnosed. We owe that to these brave men and women who put their lives on the line each and every day.

We must also address the fact that there is a stigma associated with brain injuries. Our military officials and policy writers cannot remain skeptical about the effects of Traumatic Brain Injury and how it endangers the members of our military families. We must insist that facts, on-going research, and the input of these injured personnel continue to show that Traumatic Brain Injury is real, dangerous, and a reality that must be understood and addressed.

The challenges are great. Properly diagnosing and treating these injuries in light of doubtful leadership may be the least of our worries. A recent study showed that even some military tests are failing to diagnose 40% of concussions. And we know that mild Traumatic Brain Injuries are harder to detect due to the damage and breakdown that can occur at the cellular levels, blocking important chemical processes.

We also know that even when there is a correct diagnosis, the documentation of the injuries might not even reach the soldier's permanent medical record. Often this is not the fault of the physicians in the field, but due to other circumstances. Regardless of how or why, it is clear that without that information on file, appropriate treatment will not be provided.

Today, it is estimated that 59% of all blast injuries involve Traumatic Brain Injuries. Reflect on that number … 59% is nearly six out of ten. These figures are daunting but there is hope. More and more combat and medical personnel are recognizing that once a blast occurs, Traumatic Brain Injury is something that must be properly assessed and that it is something that requires immediate attention. While we still have far to go in regards to policies surrounding Traumatic Brain Injury, great strides have been made. The ability to immediately diagnose these injuries in the field and promptly evacuate the injured to proper treatment facilities has resulted in survival rates of almost 96%.

The good news is that those who have suffered from a mild Traumatic Brain Injury usually enjoy total recovery after a year. Again, the key is that we MUST not fail to diagnose. If we do fail, these injuries will likely become severe and will alter the lives of the wounded soldiers. Those injuries that are more severe can lead to depression and Posttraumatic Stress Disorder. Those injuries follow soldiers back from the field to their homes and families and have far reaching consequences as they are linked to future medical and socioeconomic realities.

The benefits from your work today will save and improve lives. I am convinced of that, and your work extends beyond the battlefield and finds application in other fields of battle, including sports. Only two weeks ago Austrians watched live on television the skiing race in Kitzbühel, the so called Streif downhill, where an Austrian downhill racer encountered a severe Traumatic Brain Injury after he did not land the famous Mausefalle jump and bumped his head heavily on the ground. While Traumatic Brain Injury is one of the signature wounds from the current conflicts in Iraq and Afghanistan, it is also a wound that affects thousands around the world in civilian life.

As many of you may know, I am a retired General with the Austrian Military and I have been commanding international operations in four different peacekeeping missions for more than 13 years. I have seen firsthand how Posttraumatic Stress and Traumatic Brain Injuries can affect our troops. When I was a young officer I do not remember anybody talking about Posttraumatic Stress or Traumatic Brain Injuries. We simply did not know. Now we know, but our challenges are still immense.

To speak with Dr. Peale, it is imperative that we remain focused on what we are about here – finding means, methods, protocols, ideas, and applications that will address the needs that face our brave war fighters who confront Traumatic Brain Injury.

Over the next three days you will work together to ensure these brave men and women have the best quality of life available to them. I wish you a productive meeting and a great stay in our beautiful city of Vienna.

Thank you,

General Günther Greindl (ret)

President, Austrian Peacekeepers