The danger of traumatic brain injury, which afflicted U.S. troops after Iranian attack

The danger of traumatic brain injury, which afflicted U.S. troops after Iranian attack


JUDY WOODRUFF: U.S. tensions with Iran peaked
earlier this month, when U.S. forces killed a powerful Iranian general, and Iran responded
by firing missiles into bases in Iraq, with hundreds of U.S. troops on site. No Americans were killed that night, but the
Pentagon is now saying that 50 U.S. service members suffered traumatic brain injuries. Why did it take so long to announce that number?
And what makes brain injuries so difficult to diagnose and treat? Here’s Nick Schifrin. NICK SCHIFRIN: Three weeks ago tonight, American
service members braced for impact. At 11:00 p.m., the first of five barrages of ballistic
missiles hit the Al Asad Air Base in Iraq. This was the aftermath: containers that had
been bedrooms incinerated, the remains of a building where drone operators were still
working. Soldiers who have been through a lot of combat called it the biggest attack
they’d ever seen. Sergeant 1st Class Larry Jackson. SGT. 1ST CLASS LARRY JACKSON, U.S. Army: In
my 16 years in the Army, I have never seen one of that magnitude coming from an opposition
force. NICK SCHIFRIN: We now know many of those service
members suffered traumatic brain injuries, which can include anything from mild concussions
to serious injuries that affect a person’s sight, balance, and cognition. To talk about this, I’m joined by retired
Brigadier General Steve Xenakis, a psychiatrist who previously advised the chairman of the
Joint Chiefs of Staff on the physical and psychological effects of blast concussion. Dr. Xenakis, welcome back to the “NewsHour.” (CROSSTALK) NICK SCHIFRIN: These service members were
exposed to large explosions when these Iranian missiles hit that base. Explain the challenge
of treating brain injuries that you can’t see. BRIG. GEN. STEPHEN XENAKIS (RET.), U.S. Army:
Well, there’s no significant or black-and-white diagnostic test. And we have to use just clinical judgment
all the time to be able to determine how much exposure there was and how bad the exposure
was and what the impact is having on the soldiers. And you have to monitor them for some period
of time. These are very serious. This has been the signature injury of the fighting
in Iraq and Afghanistan, and there’s been hundreds of thousands of soldiers and service
members who have been exposed to it. And it gets very important for us to identify
them and then get them into treatment as soon as we can. NICK SCHIFRIN: So, you mentioned no diagnostic
test that can definitely, definitively determine the kind of traumatic brain injury this had. And you mentioned you have to monitor. That’s
because, what, the symptoms can take days or weeks to come out, right? BRIG. GEN. STEPHEN XENAKIS: Right. They can
take a while to emerge. And the soldiers — the impact occurs. The
service members, they will have a headache. Maybe they will lose their hearing. They will
have ringing in the ears. They will feel dizzy, they will feel confused, and then some will
feel better, and then a day or two later, they will start feeling very bad. And they
will have recurrent headaches. And, if they progress, I mean, that’s a sign
that they could have a long-term injury that could really affect them very seriously for
years. NICK SCHIFRIN: And the Pentagon has been questioned,
hey, why don’t it takes so long? That is one of the reasons, right, that some
of these symptoms can take a while to emerge. BRIG. GEN. STEPHEN XENAKIS: Right. And you don’t want to, right at that point,
say, hey, look, you’re badly injured, right? NICK SCHIFRIN: You have mentioned this a couple
times, but I think it’s important to put a point on it. These are injuries that we can’t see. But
they can be extremely serious, medium- and long-term. BRIG. GEN. STEPHEN XENAKIS: Absolutely. I mean, I have had patients who have had — feel
so bad that they have tried to kill themselves. And I have had patients who feel so bad, and
it’s so disorganized them, I have had one that committed murder. And I have others that
have committed very terrible crimes. So, these are debilitating. NICK SCHIFRIN: It is something that the military,
I know, has taken very seriously. And you know that more than most. I remember, back in 2011, I did a story in
Afghanistan, and the military talked then about how they were trying to change the culture. I mean, how far has military culture come
or not come from the days where it was, hey, look, soldier, you have got all your arms
and legs, go back to the front lines? How much has that culture changed, or not? BRIG. GEN. STEPHEN XENAKIS: I think it has. And I think that people recognize that it’s
a problem, just like they do now in football. And they know that this is one of the very
serious injuries you can have. But service members want to be out there.
They want to do their job. They want to fulfill their duties. They want to be with their other
soldiers and airmen and so forth. So, it’s a very tough thing to do. And it’s
a hard call to say, you know, I think we have got to take you off the field right now. NICK SCHIFRIN: And it’s not just a call, right? At one point, the military decided that this
had to be mandatory. There was a diagnostic test established so that, if certain soldiers
or Marines or airmen were close enough to a bomb blast, they were actually forced to
leave the front line. BRIG. GEN. STEPHEN XENAKIS: Yes. We set up — we set in place a set of procedures
that, if you were 25 meters or so, sometimes a little bit more, and it was serious, we
were going to take you offline for 24 hours at least, maybe a little bit longer, because
we also know that your brain has to rest after it’s been exposed to this kind of impact. NICK SCHIFRIN: Has the military gone far enough? And one question about culture is also diagnosis.
To properly diagnose traumatic brain injury, you have to have a baseline. Is the military
doing enough to require or get these baselines for its service members, so that it can later
diagnose possible brain injury? BRIG. GEN. STEPHEN XENAKIS: I think there’s
a lot of work that we could do, and we should be doing it. And I think we should be — get the assessments
right up front. We should be tracking people. We should know that they’re going to have
long-term problems. And I think we need to develop better tests. NICK SCHIFRIN: Immediately after the attack
a few weeks ago, President Trump and military officials said that there were no casualties. A week ago, when the number of these traumatic
brain injury victims was at least publicly about 30 or so, President Trump was asked
about these injuries, and said this: DONALD TRUMP, President of the United States:
I heard that they had headaches. I don’t consider them very serious injuries, relative to other
injuries that I have seen. I have seen what Iran has done with their
roadside bombs to our troops. I have seen people with no legs and with no arms. I have
seen people that were horribly, horribly injured in that area, that war, in fact, many cases,
put — those bombs put there by Soleimani, who is no longer with us. I consider them to be really bad injuries.
No, I do not consider that to be bad injuries, no. NICK SCHIFRIN: “I do not consider that to
be bad injuries.” Veteran groups have criticized the commander
in chief. Does that language downplay the severity of some of these injuries? BRIG. GEN. STEPHEN XENAKIS: I think it does,
and I think it has. And I think it really downplays how — this
impact that this can have in these members’ lives for — service members’ lives for years. So, they know that they have been injured.
They know that it really will be a problem, many of them for the rest of their lives,
as they try and get into civilian life and with their families. And I think, even though there are other injuries
that are more visible, like amputations, this is serious, and we should respect that. NICK SCHIFRIN: And it is important for the
military to do that institutionally, but also for all of society to realize that not all
injuries are visible. BRIG. GEN. STEPHEN XENAKIS: Well, and that’s
kind of the challenge with mental health, right? We don’t see the problem as visibly as we
do if you have had some kind of other physical trauma. And we have got a lot of people out
there that are really suffering because of depression, anxiety, all sorts of problems. NICK SCHIFRIN: Dr. Steve Xenakis, thank you
very much. BRIG. GEN. STEPHEN XENAKIS: Thanks for having
me.

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