Posted on Feb 3, 2020
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Background: In a 01 Feb 2020 STARS AND STRIPES article entitled "I'm not the same': Hurdles remain for troops, veterans with TBI despite increase in awareness" the following language was provided:
"More than headaches
As of Thursday, more than 60 U.S. military personnel have been diagnosed with TBI from an Iranian missile attack Jan. 8 in Iraq. That’s far from President Donald Trump’s initial announcement that no one was harmed in the attack. News of the brain injuries came out soon after and the number of cases has continued to rise.
Trump later described the injuries as “headaches,” and said he had seen far worse.
Several veterans organizations are accusing Trump of minimizing the severity of TBI."
Also, seems like this comment in the same article...
"Continuing pain
Gen. Mark Milley, chairman of the Joint Chiefs of Staff, told reporters Thursday the full extent of the injuries from the Jan. 8 missile attack might not be known for a year or two. In some cases, he said, troops would be monitored 'for the rest of their lives.' "
...is something the JCOS should have thought about at the time POTUS needed his 'wise council' to not sound unduly insensitive.
Discussion: While no one was "killed", which is what I suspect POTUS was trying to say, the words "no one was harmed" came out. We know now that these troops were apparently "harmed" because TBI is not only direct contact trauma to the head, but also concussive from the force of a concussive wave such as with an IED, grenade, or missile explosion. This may also be directly proportional to the proximity of the individual to the location of the explosion.
This said, I am NOT a neurologist, but as a retired US Navy Corpsman I have treated what were initially minor head injuries (usually cuts / bruises after some bar fight induced by alcohol on liberty), only to see such injuries get work with headaches 3-5 days later. Then requiring transfer to a hospital for further diagnosis.
The attached adult head picture shows how a concussive wave from an explosion operates. During my career when I was a young ER Corpsman we saw all sorts of trauma, but none disturbed me more that trauma to kids. The other picture shows "Shaken Baby Syndrome" that induced a form of TBI, but in infants or small children that are abused.
So my question is this:
Should POTUS, when NO ONE is "killed" also state something like 'we also have to assess the health status of those attacked for other injuries' before using words like 'no one was harmed'?
I am NOT into "political correctness"; however, I am into "health and welfare appropriateness"! Meaning, when a senior non-medical (aka Line) officer asked me about a status of someone in my sickbay, I always erred on the side of caution to make sure that for any status of an injured sailor or Marine it was based on as much information as possible so I provide an accurate status that also held to my patient's privacy, but complied with my CO's need to know.
Note: I use the words "extended-medical" to mean that a senior medical officer should brief POTUS in such a say as to help him communicate more effectively that not only was NO ONE KILLED, but, the extend of other injuries is not yet know. Frankly, instead of using "no one was harmed" the real objective was to communicate that no one was killed and that direct message language is what, at least IMHO should have been used.
Also, I don't care who is POTUS his General/Admiral level briefers should also make sure they brief POTUS in such a way so as to allow POTUS to communicate in a more effective manner.
Just saying......................
"More than headaches
As of Thursday, more than 60 U.S. military personnel have been diagnosed with TBI from an Iranian missile attack Jan. 8 in Iraq. That’s far from President Donald Trump’s initial announcement that no one was harmed in the attack. News of the brain injuries came out soon after and the number of cases has continued to rise.
Trump later described the injuries as “headaches,” and said he had seen far worse.
Several veterans organizations are accusing Trump of minimizing the severity of TBI."
Also, seems like this comment in the same article...
"Continuing pain
Gen. Mark Milley, chairman of the Joint Chiefs of Staff, told reporters Thursday the full extent of the injuries from the Jan. 8 missile attack might not be known for a year or two. In some cases, he said, troops would be monitored 'for the rest of their lives.' "
...is something the JCOS should have thought about at the time POTUS needed his 'wise council' to not sound unduly insensitive.
Discussion: While no one was "killed", which is what I suspect POTUS was trying to say, the words "no one was harmed" came out. We know now that these troops were apparently "harmed" because TBI is not only direct contact trauma to the head, but also concussive from the force of a concussive wave such as with an IED, grenade, or missile explosion. This may also be directly proportional to the proximity of the individual to the location of the explosion.
This said, I am NOT a neurologist, but as a retired US Navy Corpsman I have treated what were initially minor head injuries (usually cuts / bruises after some bar fight induced by alcohol on liberty), only to see such injuries get work with headaches 3-5 days later. Then requiring transfer to a hospital for further diagnosis.
The attached adult head picture shows how a concussive wave from an explosion operates. During my career when I was a young ER Corpsman we saw all sorts of trauma, but none disturbed me more that trauma to kids. The other picture shows "Shaken Baby Syndrome" that induced a form of TBI, but in infants or small children that are abused.
So my question is this:
Should POTUS, when NO ONE is "killed" also state something like 'we also have to assess the health status of those attacked for other injuries' before using words like 'no one was harmed'?
I am NOT into "political correctness"; however, I am into "health and welfare appropriateness"! Meaning, when a senior non-medical (aka Line) officer asked me about a status of someone in my sickbay, I always erred on the side of caution to make sure that for any status of an injured sailor or Marine it was based on as much information as possible so I provide an accurate status that also held to my patient's privacy, but complied with my CO's need to know.
Note: I use the words "extended-medical" to mean that a senior medical officer should brief POTUS in such a say as to help him communicate more effectively that not only was NO ONE KILLED, but, the extend of other injuries is not yet know. Frankly, instead of using "no one was harmed" the real objective was to communicate that no one was killed and that direct message language is what, at least IMHO should have been used.
Also, I don't care who is POTUS his General/Admiral level briefers should also make sure they brief POTUS in such a way so as to allow POTUS to communicate in a more effective manner.
Just saying......................
Posted in these groups: 
Office of the President (POTUS)
TBI
Healthcare
Health and Wellness
Disabled Veterans
Office of the President (POTUS) TBI Healthcare Health and Wellness Disabled Veterans
Edited 5 y ago
Posted 5 y ago
Responses: 14
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I have to say, it does seem like there is an excessively high number of concussions from a single rocket attack. I realize that these are bigger than anything the Iraqis or Afghans threw at us, but I don't know if we had that many injuries from rocket and mortar attacks in a whole tour, and we got several attacks per day. I am on the outside looking in, but it feels like a Purple Heart grab.
Not to belittle any injuries suffered in the slightest. I know several Soldiers who got rung and never quite were the same. Sometimes I wonder if all those IEDs made me different... or if I'm just getting old.
But in terms of what should have been said, the President's people need to ensure that he knows what is really going on so that he doesn't get facts wrong when he comments on situations. If he goes off the reservation and comments off the cuff, there isn't much they can do about it.
Not to belittle any injuries suffered in the slightest. I know several Soldiers who got rung and never quite were the same. Sometimes I wonder if all those IEDs made me different... or if I'm just getting old.
But in terms of what should have been said, the President's people need to ensure that he knows what is really going on so that he doesn't get facts wrong when he comments on situations. If he goes off the reservation and comments off the cuff, there isn't much they can do about it.
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MSgt (Join to see)
How many of us have had our “bell rung” over the years on various deployment? How many just popped a couple advil and never went to sick call?
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LTC Jason Mackay
I don’t think it’s a grab. Say an interview with a few people on the ground the following morning. Report was they had 100% of positions manned (not in bunkers) because they were unsure what the threat was. A TBM is carry thousands of tons of explosives. It’s not a chinese 122mm. I Accept it at face value. TBI is not a PH I want.
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SSgt Richard Kensinger
I highly recommend you visit Brainline.ORG and review "A Primer for Clinicians" and you develop a greater sense about severity and mortality of blast trauma.
Rich
Rich
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1SG (Join to see)
SSgt Richard Kensinger - My comment is informed by my first hand experience in combat in that area. Four tours of it. While I am open to what I don't know about the circumstances of all these concussions, I am genuinely surprised by the exceedingly high number of reported TBIs with no other physical injuries reported. Having been in close proximity to 40+ explosions - some of them pretty damn big ones - I have questions.
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Cpl Jeff N.
"I have yet to find "mild" concussions during these types of attacks.". There are at least 3 types of concussion recognized (Some orgs recognize as many as 6) They are grades 1, 2, and 3 typically described as mild moderate and severe. It appears your medical qualifications are as dubious as your psychological qualifications. Are you actually suggesting there cannot be a mild concussion in a given attack?
I know this as my youngest son just had a severe concussions and I have had to consult with many real doctors/neurologists on the subject. They describe the varying levels of concussions, something you say you could never find. Do you have a degree in neurology too?
I know this as my youngest son just had a severe concussions and I have had to consult with many real doctors/neurologists on the subject. They describe the varying levels of concussions, something you say you could never find. Do you have a degree in neurology too?
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SSgt Richard Kensinger
SGT Robert Pryor - See Brainline.org "A Primer for Clinicians" about the severity of brain trauma and its morbidity and mortality.
Rich
Rich
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SGT Robert Pryor
SSgt Richard Kensinger - I read it. A lot of it rings true to me, but some things, as I'm sure you know, differ from the military. They kind of gloss over the relative effectiveness of various explosives (I was a demo man). I did have most of those injuries, but some of the lessor ones mentioned in the article I can't be too sure about. I was wounded by rocket propelled grenades, satchel charges and small arms fire. As for the lung injury from explosions -- I have no way of knowing if that pertains to me -- probably not. I was shot in the base of the neck once, center of my chest with the bullet stopping near my heart, and in the right front upper quadrant of the chest with the round exiting just below my shoulder blade. Did the bullet mess up my lungs or was it the over-pressurization? The hell if I know. I do know that my lungs were messed up a bit because of all the tubes they had in me. I didn't loose any extremity through amputation, but my right forearm was pretty messed up -- loosing the outer muscle, having the radial and medial nerves severed plus the radius, ulna and several metacarpal bones fractured. Actually the right arm injuries were far more extensive than that, but you get the picture. Both legs were shattered. I advanced through a wheel chair, crutches and eventually leg braces, which I finally set aside about 15 years ago. (Never let them see you sweat) The biggest problem with my case was the sheer overwhelming number of wounds I received that night. So those working to save my life had for more important things to deal with than much of what was mentioned in that article. It was about impossible to separate the TBI from everything else. And like the article implies, it's pretty hard to separate TBI from PTSD. I saw some horrendous things that night. Things I still don't want to discuss out of respect and reverence for the dead. Those people died for that in which they believed and I honor their sacrifice, in spite of what they did to me. My biggest worry when I came out of a comma was two major wound I received within an inch of making me a girl. I like girls just fine, but didn't want to become one. So I have never considered my TBI to be serious when compared to everything else. Damn, what I've written here is only a very small part of my injuries. No wonder other folks felt I was severely wounded. I feel like it was no big deal and really wanted to go back into combat when they released me from the hospital. But alas, that was then, this is now. Not to take away anything from anyone with TBI. I know relatively minor TBIs can kill, so a thorough examination and appropriate treatment are indicated.
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SSgt Richard Kensinger
Bless you for having served in combat. Most of us did not. So glad you survived. I conduct my research to honor those who served in combat, those who never came home alive, and those who came back still quite traumatized. I've counseled them at length. They have taken me into those zones and I do not abandon during the process. We refer to this as revisit, relive, and revise. I can send you copies of my research. It is painful to relive it. " [login to see] ".
My very best to you and those you love,
Rich
My very best to you and those you love,
Rich
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The POTUS doesnt respond well to being briefed. He is briefed and doesn’t retain it or is briefed something and discards it for a variety of reasons.
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Cpl Jeff N.
Dick, you offer nothing of substance in your analysis. You are entitled to your opinion of Trump but to attempt to stretch it to a clinical observation is complete BS and you know it. Your articles are words on paper. You may think them clever, well thought out and on the mark but since you have never treated the object of the paper you don't really know anything.
Your notion that I am denigrating a "fact teller" is laughable. What fact have you actually put out there. None is the answer Dick. You have no facts about Trumps mental health as you have never evaluated him. You hate him, loathe him and that is fine but you are the one that needs help, not him.
What would you call a professional clinician that attempts to diagnose patients they have never met? Unethical perhaps?
Why don't you peruse this from the NIH. I will cut an paste the first paragraph for you. Does the Goldwater Rule sound like something you are doing? Why yes Dick, it does.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5809224/
Psychiatrists should never provide professional opinions in the media about public figures they have not personally examined, the American Psychiatric Association reiterated in a statement. The association was reminding members about what is known as “The Goldwater Rule” — a guideline penned in 1973 after more than 1000 psychiatrists went public with views about US presidential candidate Barry Goldwater’s fitness to hold office, calling him, among other things, “a dangerous lunatic.”
Your notion that I am denigrating a "fact teller" is laughable. What fact have you actually put out there. None is the answer Dick. You have no facts about Trumps mental health as you have never evaluated him. You hate him, loathe him and that is fine but you are the one that needs help, not him.
What would you call a professional clinician that attempts to diagnose patients they have never met? Unethical perhaps?
Why don't you peruse this from the NIH. I will cut an paste the first paragraph for you. Does the Goldwater Rule sound like something you are doing? Why yes Dick, it does.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5809224/
Psychiatrists should never provide professional opinions in the media about public figures they have not personally examined, the American Psychiatric Association reiterated in a statement. The association was reminding members about what is known as “The Goldwater Rule” — a guideline penned in 1973 after more than 1000 psychiatrists went public with views about US presidential candidate Barry Goldwater’s fitness to hold office, calling him, among other things, “a dangerous lunatic.”
Is it ever ethical for doctors to diagnose patients they haven’t examined?
Psychiatrists should never provide professional opinions in the media about public figures they have not personally examined, the American Psychiatric Association reiterated in a statement. The association was reminding members about what is known as “The Goldwater Rule” — a guideline penned in 1973 after more than 1000 psychiatrists went public with views about US presidential candidate Barry Goldwater’s fitness to hold office, calling him,...
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SSgt Richard Kensinger
I am not a psychiatrist and not a member of APA. As he is not my patient, I am not under any obligation to protect his PHI. If he were my patient, I would never release this info w/o his written expressed permission as it is unethical/illegal to do so. You remain quite under-informed of my clinical profession.
Rich
Rich
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Cpl Jeff N.
We can have a treaty if you can stop acting as though your profession gives you insight and final judgment on peoples mental health who you have never met or treated. Disagreeing with Trump policy and even antics is fair game but attempting to clinically assess his mental state as a mental health professional in a forum like this is over the line and I think you know that. You are pretty far down the path on doing so and I know it can be difficult to stop, put it in reverse etc.
Using your mental health credentials (whatever they may be) to attempt to bludgeon people you disagree with is unprofessional and reflects poorly on your profession.
Using your mental health credentials (whatever they may be) to attempt to bludgeon people you disagree with is unprofessional and reflects poorly on your profession.
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