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5 things cops need to know about traumatic brain injury

Blast exposure is an occupational hazard for tactical officers, and it’s important to know the risks and take steps to address them


The following is paid content sponsored by BlackBox Biometrics Inc
By Bob Sullivan for PoliceOne BrandFocus

Traumatic brain injury poses a significant hazard for law enforcement personnel, particularly tactical officers and breachers, who are routinely exposed to explosive events in training and operations. Too often, officers and their superiors are unaware that a problem may exist after a blast or are reluctant to admit they might need medical attention.

As public awareness about concussions grows, it’s time to address the risk of blast traumatic brain injury (bTBI) on the job. Even low-level blast exposure can be harmful, and it’s important to identify officers who may need medical treatment. Here are five things cops need to know about traumatic brain injury.

Blast shockwaves can create a a sharp increase in pressure that moves through the brain, damaging brain cells, compromising blood vessels and causing brain inflammation. (Photo/Pixabay)
Blast shockwaves can create a a sharp increase in pressure that moves through the brain, damaging brain cells, compromising blood vessels and causing brain inflammation. (Photo/Pixabay)

1. Concussion is just one type of TBI. 
Concussions are a type of head injury that cause an alteration in mental status when the brain shifts inside the skull and damage [1]. Concussions can occur after seemingly minor injuries, and symptoms may go unnoticed. The best-known risks of head injury for law enforcement officers are falls, vehicle crashes and blows to the head.

A lesser-known but critical risk, particularly for tactical officers, comes from exposure to shockwaves after a blast, such as an explosive forced entry or flashbang devices in training and operations.

Blast-related TBI is different from non-blast TBI, although the symptoms are similar. Instead of impact trauma from an object, blast shockwaves create a drastic increase in pressure that propagates through the brain, damaging brain cells, compromising blood vessels and causing brain inflammation [2].

2. Recognize the symptoms of blast TBI. 
Shortly after a head injury, victims may be confused, have a blank expression, or have difficulty answering simple questions. There may be a period of amnesia around the time of the injury, and they may complain of a headache or dizziness. Blurred vision, “seeing stars” or double vision are also signs of concussion, and vomiting is a sign of a severe concussion [1].

Blast-related TBI is more insidious – symptoms may take days, weeks or months to surface, but the injury is no less real [3]. Symptoms of “Breacher’s Brain,” as the condition is known by soldiers and SWAT officers, are very similar to concussion symptoms and include headaches, dizziness, fatigue, irritability, confusion, memory problems and sleep disturbances, as well as depression and anxiety.

One challenge of diagnosing TBI is that officers may attribute these symptoms to other aspects of the job, such as shift work, dehydration and exposure to trauma. It’s critical to monitor officers routinely exposed to low-level blasts and document their exposure in order to identify those at risk for bTBI and seek medical attention when needed.

3. Understand the risks of repetitive low-level exposure. 
Pressure from exposure to blast shockwaves is measured in pounds per square inch (psi). The generally accepted “safe” blast pressure threshold is 4 psi, which is the most widely accepted guideline used by military and police to determine a safe standoff distance from the blast.

It’s not uncommon for a tactical officer to encounter multiple blast events on the job, making blast exposure an occupational hazard. In addition to the damaging effects of a single large blast, recent studies have revealed a cumulative negative effect associated with chronic low-level blast exposures, indicating that even small exposures can add up to cause cognitive impairment [4].

A study of a two-week training exercise for breachers showed a significant decline in reaction time and cognitive performance. Participants also reported fatigue, memory problems, headaches and slow thought processes after the exercise [4]. Another study found that repeated low-level occupational blast exposure produced symptoms similar to concussion, which interfered with daily function and increased with history of exposure [5]. These studies suggest that the accepted minimum safe distance may be insufficient to prevent long-term brain injury.

4. One TBI increases the risk and severity of future injuries. 
Monitoring exposure to blast shockwaves over time can help identify officers who are at risk for future brain injury and impairment. In soldiers, a history of blast-related TBI has been shown to worsen the initial symptoms of later TBIs. Also, soldiers in a study of blast-related TBI were at higher risk of developing post-traumatic stress disorder (PTSD) than soldiers with no history of concussions [6].

Exposure to a series of low-level blast events may not cause symptoms until much later, and if left untreated, a brain injury can get worse over time. Because cognitive or motor deficits may not manifest right away, it’s important to monitor an officer’s exposures and symptoms over time in order to identify possible bTBI and seek treatment, as well as take steps to reduce further exposures and prevent further injury.

5. TBI may lead to long-term disability. 
Multiple brain injuries over time can cause a condition known as chronic traumatic encephalopathy (CTE). This is a progressive disease that can occur years after recovery from an incident and currently can only be diagnosed post-mortem. Early symptoms of CTE include short-term memory problems, irritability, impaired functioning, depression, anger issues and substance abuse.

CTE can progress to worsened symptoms, including dementia at an early age. Evidence of CTE has been found in autopsies of soldiers who were exposed to blast shockwaves, similar to athletes who had a history of multiple concussions [7]. Furthermore, blast exposure may accelerate brain aging, leading to long-term deficits that affect quality of life and job performance, as well as increasing the risk of early-onset Alzheimer’s and other neurological disorders [8].

Low-level blast wave exposure poses a significant health risk to tactical law enforcement officers. Monitoring the level of blast exposure can help detect the risk of TBI to determine when medical assessment is needed to promote officer safety and prevent future disability.

For more information on TBI and tools to monitor blast exposure, contact BlackBox Biometrics Inc.

References  
1. Bernhardt D, Young M, Talvera F. Concussion treatment and management. Medscape. 2015, September 21. Retrieved from: http://emedicine.medscape.com/article/92095-overview  
2. Ahmed F, Gyorgy A, Kamnaksh A, et al. Time-dependent changes of protein biomarker levels in the cerebrospinal fluid after blast traumatic brain injury. Electrophoresis. 2012;33(24):3705-3711.  
3. Institute of Medicine. Gulf War and Health, Volume 9: Long-Term Effects of Blast Exposures. Washington, DC: National Academies Press; 2014.  
4. Tate CM, Wang KK, Eonta S, et al. Serum brain biomarker level, neurocognitive performance, and self-reported symptom changes in soldiers repeatedly exposed to low-level blast: a breacher pilot study. Journal of Neurotrauma 2013; 30(19):1620-30.  
5. Carr W, Polejaeva E, Grome A, et al. Relation of repeated low-level blast exposure with symptomology similar to concussion. J Head Trauma Rehabil. 2015;30(1):47-55.  
6. Kontos AP, Kotwal RS, Elbin RJ, et al. Residual effects of combat-related mild traumatic brain injury. J Neurotrauma. 2013;30(8):680-686.  
7. Goldstein LE, Fisher AM, Tagge CA, et al. Chronic traumatic encephalopathy in blast-exposed military veterans and a blast neurotrauma mouse model. Sci Transl Med. 2012;4(134):134ra60.  
8. Trotter, Benjamin B., et al. (2015). Military Blast Exposure, Ageing and White Matter Integrity. Brain, A Journal of Neurology, 138 (2015), pp. 2278‐2292.

About the Author  
Bob Sullivan, MS, NRP, is a paramedic instructor at Delaware Technical Community College and columnist for EMS1.com. He has been in EMS since 1999 and has worked as a paramedic in private, fire-based, volunteer and municipal EMS services. Contact Bob at his blog, The EMS Patient Perspective.

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