Susan Connors: Dr. Gualtieri, it seems as if one of the Cmdr. Richard Jadick, USN: I think my experience has
most pressing issues is the lack of a comprehensive trau- been really twofold. I’ve had the front-line experience
matic brain injury (TBI) screening program within DoD. where every Marine who came to me ... would get evacu-
Opinions differ as to a preferred protocol. Can you explain ated to the back. So ... the front line is not a place to
the difference between screening and clinical assessment, screen. I look at that point to [ask], ‘Is this Marine able to
and give us your take on this issue? get back into the fi ght or not?’ and then I evacuate them.
Specifi cally, do you think Congress should demand im- It’s really that second line, that second echelon of care,
mediate implementation of widespread screening? Should where they get forwarded and evacuated to, where they
screening occur at several points in time to ensure proper need to really look [at] and screen and develop a situa-
identifi cation of TBI? tion that puts these Marines, these sailors, these soldiers,
back into the treatment pipeline they need.
Dr. Thomas Gualtieri: I don’t know whether Congress PTSD and the symptoms of TBI, specifi cally mild TBI,
should or not. I think it ought to be an executive deci- are very similar, and with anybody who has been in com-
sion. If you began [screening] tomorrow, you probably bat, they will have several events that could be causing
could screen the entire force within 60 days. PTSD. And on top of that, [they] could have a blast effect
Screening for traumatic brain injury is simply a ques- or TBI [or] a mild TBI that is not apparent to anybody,
tion of administering a baseline cognitive test. And this but now you’ve got these confounding symptoms that put
can be done by computer and by comparing subsequent them in different categories or the same categories.
performance to the patient’s baseline performance. So as you look down the road at how to treat these
The technology actually has been around for about 25 people, every combat veteran deserves a multidisci-
years, and in fact, the military has been interested in plinary approach with a neuropsychologist [and] a neu-
doing that [for] seven. Ten years ago, the idea of a single ropsychiatrist, and I’ve had the opportunity where I’m at
computerized database, for example, centered at Walter in Augusta, [Ga.], to look at the VA model there.
Reed [Army Medical Center, Washington, D.C.,] was It’s DoD-funded but VA-run. [The VA has] a neu-
developed, but it was never really implemented. The ropsychologist on staff, and [the neuropsychologist is]
concrete. [He or she is] the same person who [has] taken
care of this patient from the minute [he or she] shows up
Instead of benefit-
at the door to the time [he or she] gets discharged, back
on active duty or not.
ing the servicemember,
As far as delineating between PTSD and mild TBI,
I think they’re so intertwined if you come back from a
it confuses them so
combat environment, that you’re doing a disservice by
not providing all of the opportunity, all of your medical
they can’t actually ac-
power in a team approach toward these patients.
cess the benefit itself.
Connors: [Dr. Gualtieri], just briefl y list some of the com-
mon consequences of TBI.
— Meredith Beck
Gualtieri: [TBIs] are rated as mild, moderate, and se-
vere. A simple way of looking at them is [to examine the
length of ] unconsciousness after a brain injury. A con-
reason I think it wasn’t implemented was simply be- cussion is more or less synonymous with a mild brain in-
cause the computer programs were very, very clumsy jury, and concussions range from what are called “dings”
and diffi cult to actually use. ... when you just have a momentary lapse after you get hit
So, yes, I think the application of universal baseline on the head, and you’re momentarily confused or dazed.
screening is something that we absolutely ought to do A concussion can be associated with up to 30 minutes’
and is something that could be done almost immediately. loss of consciousness.
Severe TBI actually is associated with substantial physi-
Connors: Commander Jadick, how does the overlap be- cal damage to the brain — when the patient is rendered un-
tween PTSD and TBI symptoms complicate the situation in conscious, [he or she is] in a deep coma, and it tends to be
terms of screening and treatment? What’s been your experi- persistent. People with severe TBI recover, but they almost
ence? What do you think is the best way to address this? invariably have some kind of defi cit. It’s either a motor
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