Brain Injury Awareness Part 2: Screening puts injured on right path to recovery
The HEADS card helps medics, leaders, and battle buddies in the field evaluate such injuries. HEADS stands for Headaches, Ears ringing, Amnesia, Dizziness, and "Something feels wrong" - all symptoms of concussion.
EDitor's Note: This article has a graphic photo below, which some readers may find unsettling.
A bad decision and a freak accident sent a Coast Guardsman through the four phases of traumatic brain injury: prevention, screening, treatment, and recovery. Petty Officer 3rd Class Colin Woodside was rock climbing with a friend in the Pacific Northwest in October 2014. When he forgot equipment at the top of the climb, Woodside scrambled back up the rocky ledge to retrieve it. Just this once he did not wear a helmet or use a safety rope.
“It was a place I climbed many times,” he said. “I was comfortable, and it wasn’t a hard climb.”
A fall of 50 feet left Woodside with a TBI requiring three years – and counting – of treatment and recovery. A highlight has been a return to full active duty as a maritime enforcement specialist about six months ago. For Woodside, the diagnosis of a severe TBI came quickly, but screening for the injury is not always clear cut.
“With moderate and severe TBIs, there are typically more obvious injuries, such as loss of consciousness,” said Dr. Katharine Stout, director of clinical affairs and a physical therapist at the Defense and Veterans Brain Injury Center, or DVBIC. Mild TBIs, however, aren’t marked with a massive head wound. Better known as concussions, mild TBIs can occur when someone is too close to a blast or has a collision in a sporting event. In many cases, they leave no apparent outside wound.
The acronym HEADS helps medics, leaders, and battle buddies in the field evaluate such injuries. HEADS stands for Headaches, Ears ringing, Amnesia, Dizziness, and “Something feels wrong” – all symptoms of concussion.
“The HEADS cards support early screening if there are no medical personnel available,” said Stout. “Then the injured person’s buddy can say, ‘You better get checked out at the aid station,’ where a more complete evaluation can be done.”
If a service member is alone, the DVBIC recommends looking for the HEADS signs of TBI, as well as other symptoms like sleep disturbances, nausea or vomiting, poor concentration, and anxiety or depression. DVBIC also says anyone with symptoms should seek medical attention immediately and follow all medical orders.
After initial formal medical evaluation for a TBI, Stout said care providers can look for other less obvious symptoms: eyes failing to track an object, pupils not reacting properly, or speech, motor skills, and balance problems.
“If any of those come back as positive, then the injured person would get referred to a higher level of care,” said Stout. “There’s a sequential screening and assessment to identify those potentially concussed and get them treated.”
After the initial check in the field using the HEADS card, and following the first evaluation by a medical provider, Stout said medical providers can order neuroimaging screenings in specific instances based on clinical guidelines.
In cases where a patient has suffered more than one concussion, clinical algorithms help clinicians decide on next steps. Symptoms also help determine referrals to specialty clinics. In addition, the DVBIC offers clinicians a suite of tools, including the latest case management and research data. Families and caregivers can also get information through the DVBIC.
For Woodside, his visible wound was an obvious sign he was severely injured. Doctors told him actions taken that day saved his life. His friend kept Woodside talking, and medics and doctors accurately screened his injury, treated him, and got him into the operating room just in time.
Woodside talks about his treatment and road to recovery in the final two articles in this series. See Woodside’s full story on DVBIC’s A Head for the Future website.