Posts Tagged ‘Afghanistan’


Over the past 15 years, more than 330,000 US soldiers have suffered a traumatic brain injury. Many were evacuated by air for further treatment. A new study has found evidence that such air evacuations may pose a significant added risk, potentially causing more damage to already injured brains.

Over the past 15 years, more than 330,000 U.S. soldiers have suffered a traumatic brain injury (TBI). It is one of the leading causes of death and disability connected to the country’s recent conflicts in Afghanistan and Iraq. Many of these patients were evacuated by air from these countries to Europe and the U.S. for further treatment. In general, these patients were flown quickly to hospitals outside the battle zone, where more extensive treatment was available.

But now a new study by researchers at the University of Maryland School of Medicine has found evidence that such air evacuations may pose a significant added risk, potentially causing more damage to already injured brains. The study is the first to suggest that air evacuation may be hazardous for TBI patients. The study was published in the Journal of Neurotrauma.

“This research shows that exposure to reduced barometric pressure, as occurs on military planes used for evacuation, substantially worsens neurological function and increases brain cell loss after experimental TBI — even when oxygen levels are kept in the normal range. It suggests that we need to carefully re-evaluate the cost-benefit of air transport in the first days after injury,” said lead researcher Alan Faden, MD, the David S. Brown Professor in Trauma in the Departments of Anesthesiology, Anatomy & Neurobiology, Neurology, and Neurosurgery, and director, Shock, Trauma and Anesthesiology Research Center (STAR) as well as the National Study Center for Trauma and Emergency Medical Services.

About a quarter of all injured soldiers evacuated from Afghanistan and Iraq have suffered head injuries.

Faden and his colleagues tested rats that were subjected to TBI, using a model that simulates key aspects of human brain injury. Animals were exposed to six hours of lowered air pressure, known as hypobaria, at levels that simulated conditions during transport; control animals were exposed to normal pressure. All the animals received extra oxygen to restore normal oxygen concentrations in the blood. In another study, animals received oxygen, either as in the first study or at much higher 100 percent concentration, which is often used during military air evacuations. On its own, low air pressure worsened long-term cognitive function and increased chronic brain inflammation and brain tissue loss. Pure oxygen further worsened outcomes.

Faden and his colleagues believe the findings raise concerns about the increased use of relatively early air evacuation, and suggest that this potential risk should be weighed against the benefits of improved care after evacuation. It may be necessary, he says, to change the current policy for TBI patients and delaying air evacuation in many cases.

In an accompanying editorial, Patrick Kochanek, MD, a leading expert on TBI and trauma care at the University of Pittsburgh, called the findings “highly novel and eye-opening,” and said that they could have “impactful clinical relevance for the field of traumatic brain injury in both military and civilian applications.”

Faden and colleagues believe that one of the mechanisms by which hypobaria worsens TBI is by increasing persistent brain inflammation after injury. They are currently examining how this process occurs and have tested treatments that can reduce the risks of air evacuation. Early results are promising. Scientists suspect that breathing pure oxygen could worsen TBI by increasing production of dangerous free radicals in the brain. After brain injury, these free radicals flood the site of injury, and pure oxygen may further boost these levels. Several recent studies from trauma centers, including from the R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center, have found evidence that using 100 percent oxygen in trauma patients may be counterproductive.

Journal Reference:

Jacob W Skovira, Shruti V Kabadi, Junfang Wu, Zaorui Zhao, Joseph DuBose, Robert E Rosenthal, Gary Fiskum, Alan I Faden. Simulated Aeromedical Evacuation Exacerbates Experimental Brain Injury. Journal of Neurotrauma, 2015; DOI: 10.1089/neu.2015.4189

http://www.sciencedaily.com/releases/2015/11/151130110013.htm

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A Royal Marine who had his leg blown off, leaving his Liverpool FC tattoo missing a word and reading You’ll Never Walk, has defied the odds to become a runner and climber.

Andy Grant, 26, had his limb amputated after he stood on an improvised explosive device (IED) while on routine foot patrol in Afghanistan.

He had an operation to remove the leg below the knee and woke up to find the word Alone missing from his You’ll Never Walk Alone tattoo.

However, the father of three used the ironic inking as inspiration and went through vigorous rehabilitation sessions for 18 months.

He has not only learnt to walk, but is now closing in on a running world record.

Mr Grant, who lives in Liverpool and was serving with 45 Commando at the time of the blast, said he has always seen the funny side.

He said: “I am a huge Liverpool fan so had the Liver bird and the words to the song You’ll Never Walk Alone on my leg.

“The tattoo that I have been left with has always been a bit of a joke. I use it in my motivational speeches.

“It is ironic that it says I will never walk as I have gone on to run 10k in 40 mins. At the moment I am just two minutes off a record record for the 10k for a single leg amputee and I have that in my sights.

“It is bizarre and I just laugh about it. But it adds to my story I guess. The fact is that regardless of what the words says, the operation allowed me to walk and run and do so much else. You have got to see the funny side of it.

“I also won a couple of gold medals at the Invictus Games and got to abseil the shard so I don’t think I have done too badly.

“I guess I did use the tattoo I was left with as an extra inspiration. But I was always going to prove it wrong.”

The impact of the IED blast in Sangin six years ago severed Mr Grant’s femoral artery and took out a “big chunk” of his thigh. He broke both the fibula and tibia in his right leg and lost 6cm of bone.

But two years after the blast, the 26-year-old decided to have his right leg amputated after watching comrades with similar injuries enjoying activities with their prosthetic legs.

He can still recall the conversation he had with surgeon Anthony Lambert when he woke up.

Mr Lambert told him: “Well, we had to raise a flap of skin on your leg to cover the bone ends… and it’s meant that your Liverpool Football Club tattoos are a bit messed up. The Liver bird is a bit all over the place, and your tattoo now says ‘you’ll never walk’.”

The date of his blast, February 3, and the date of his amputation, November 25, are both anniversaries that Andy marks.

He said: “The anniversary of the blast is a bitter sweet day, but one that I like to get together with friends and family.

“I am very proud of my achievements and like to turn my story around to try and inspire other people about what they can achieve in the face of adversity.

“I am all about looking forward. I can not undo what happened and I have no regrets. I am all about making the best of a bad situation.”

Such is his positive outlook on life now, he says he feels like the bomb blast was “worthwhile”.

He said: “It’s been a rollercoaster ride of emotions, and it’s been bittersweet for me. On that day in 2009 I basically ended my career in the corps. I lost a bit of myself on that day and, as a 20-year-old I changed.

“It’s been hard when you look at it like that, but on the flip side I’ve had some amazing experiences that almost make it seem like it was worthwhile.

“It is weird to hear myself say that, but it just shows the level of recovery. It’s opened so many doors.

“My job as an inspirational speaker takes me around the world; I’ve started amazing relationships with people; I have three children and an amazing family; I’m looking to row across the Atlantic; and I’m hoping to be picked for the Paralympics next year.

“My life has moved on in an amazing way and it’s all down to what happened. It’s given me more of a life than I probably would have had.”

The Liverpool Football Club fan left the Royal Marines in May, 2012 and now works as a motivational speaker.

http://www.telegraph.co.uk/news/uknews/defence/11394618/Royal-Marines-Liverpool-FC-tattoo-reads-Youll-Never-Walk-after-amputation.html