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An Ounce of Prevention is Worth a Pound of Cure

While every prepper knows to have more than a basic first-aid kit and probably even has some experience treating more serious injuries, there is one type of wound that can present very real challenges when experienced physicians and modern medical facilities aren’t available. This is the traumatic brain injury (TBI), something that is still largely misunderstood and if left untreated, can present very serious issues.

The Centers for Disease Control and Prevention (CDC) have defined a traumatic brain injury as “a disruption in the normal function of the brain that could be caused by a bump, blow or jolt to the head, or a penetrating head injury.”

The effects of TBI from head wounds such as concussions have been studied more closely in recent years, in no small part due to concerns about injuries suffered by football players. In addition, TBI has been studied as many military veterans have been exposed to blasts from combat and training. Only in recent years has the correlation between injuries from combat action, direct impacts suffered by athletes and TBI begun to be understood.

TBI can occur from not only combat and professional sports but in common accidents such as car wrecks and mishaps while bicycling or on a construction site. The problems of TBI could increase following a natural disaster or a breakdown of civilization.

Even a localized event that limits the ability of first responders to reach an injured party, or a victim to reach medical care, could have lifelong effects. TBI can be as serious as a stroke, heart attack or other life-threatening medical condition.

TBI Basics

Brain injuries can be very problematic not just because of the dangers the initial wound presents but because of the long-term and lasting effects.

Depending on the severity of the brain injury, a person may experience a change in consciousness, and that can range from simply becoming dazed and/or confused to a complete loss of consciousness.

It isn’t uncommon for a person to lose memory of what happened immediately before or after the event that caused the injury, and this can linger for hours to years or longer.

According to the Centers for Disease Control and Prevention, more than 1.7 million people sustain traumatic brain injuries annually, and TBI is a contributing factor for nearly a third of injury-related deaths and 235,000 yearly hospitalizations.

Only in recent years has it become understood that the volume of warfighters’ injuries are, in fact, due to a form of TBI.

The United States Department of Defense (DoD) has estimated that 22 percent of all combat casualties from Afghanistan and Iraq are brain injuries, compared to 12 percent of Vietnam War-related combat injuries.

One major misconception about TBIs is that a mild head injury isn’t a serious problem. In large part because football players (among other athletes) suffered these head wounds and seemingly recovered, the problem has been ignored.

In fact, most TBI injuries can be considered mild, but even in these cases it can involve serious and long-term effects on areas such as thinking ability, memory, mood and, notably, focus. Other lasting symptoms can include headaches and endocrine, vision and hearing problems.

The Centers for Disease Control and Prevention have defined a traumatic brain injury as “a disruption in the normal function of the brain that could be caused by a bump, blow or jolt to the head, or a penetrating head injury.”

Mild TBI (mTBI), more commonly described as a concussion, can be far more difficult to identify than a serious TBI, often because there may be no observable head injury.

Moreover, symptoms from mTBI can also resemble post traumatic stress disorders (PTSD), making it more difficult to tell if someone is suffering from TBI.

The CDC reports that in 2014, there were 2.87 million TBI-related emergency department visits, hospitalizations and deaths (EDHDs), 837,000 of which involved children.

You can learn more about traumatic brain injury and concussion at CDC.gov/traumaticbraininjury/data/tbi-edhd.html

Address a Head Injury Immediately

Any serious head injury should be treated immediately. Ideally this would involve a trip to the emergency room or urgent care, where X-rays and other head scans could be conducted.

In troubled times to come, or after a major disaster such as a hurricane, fire or flood, this may not be possible.

Traumatic brain injury can be difficult to detect because of its typical lack of physical
markers. U.S. Air Force photo

Fortunately, TBI has been studied well enough that experts have some advice on how to treat the victim immediately after an accident or traumatic event and how to care for that person in the near term.

“If an injury truly leaves someone unconscious, the response depends on the context where the victim is,” explained Dr. Andrés M. Rubiano, a noted expert in TBI.

“If the victim is in an area without emergency medical service (EMS) coverage, the person needs to be checked for breathing and checked for other injuries including bumps, cuts, swelling that can define if control of a local bleeding is required by hand compression with any available means, (such as a) towel or scarf.”

“TBI can occur from not only combat and professional sports, but also in everyday activities such as car accidents, bicycling or construction work.”

If the victim is not breathing, then the person treating the individual will need to try to open the victim’s mouth and check to see if air is moving. Basic CPR can be applied as needed, but efforts should be made to keep the individual as stable as possible.

“It is recommended that you do not move the person unless necessary to avoid moving (the) person’s neck as much as possible,” added Dr. Rubiano.

Understanding  a Concussion

Even if someone was not knocked out, there is still a chance that he/she suffered a TBI. Unlike in the movies and TV shows, people are not knocked out cold and immediately recover by shaking it off.

Losing consciousness, even briefly, should be taken very seriously and could be a sign of a TBI.

Rock climbing is another activity where a head wound could be very serious. (Public Domain)

More important, even a mild hit on the head can be a serious reason for concern because it isn’t known what impact that blow had on the brain. Anyone who shows signs of moderate or severe TBI should receive medical attention as soon as possible.

However, little can be done to reverse the initial brain damage caused by trauma, so it is necessary to stabilize an individual with TBI and focus instead on preventing further injury.

The primary concern is that the brain continues to receive the proper oxygen supply, so it is necessary to maintain adequate blood flow and to control blood pressure. Failure to address these issues immediately after an injury can have lasting effects.

Seemingly simple tasks like working on shelter can cause a serious injury. When working on construction a suitable helmet or hardhat should always be worn. (Public Domain)

TBI was largely undiagnosed in past wars, but the military has made strides in addressing head wounds in the field in recent years. U.S. Army photo

This is why it is necessary to take concussions very seriously.

“Concussions include a transient or more prolonged brain activity dysfunction, including memory dysfunction or dizziness or vomiting or blurred vision or several other symptoms,” said Dr. Rubiano. “The extent of a bump is not always related to the amount of internal damage.”

The Next 24 Hours

As modern medical facilities may be unavailable, addressing a wound in the hours after an injury is also crucial. In the immediate 24 hours after a victim suffers a head injury, they should be checked repeatedly for blurred vision, dizziness, headache, nausea and memory issues.

Defense and Veterans Brain Injusry Center (DVBIC), shown here, studies brain injuries and is the principal integrator and authority on psychological health and traumatic brain injury for the U.S. Defense Department. U.S. Air Force photo

One thing not to do is to let the victim of a head wound get uninterrupted rest and sleep it off. While the body does heal during sleep cycles, victims should be woken up regularly.

“If the injured is sleepy, you need to wake up him/her frequently in order to evaluate these symptoms,” said Dr. Rubiano. “After 24 hours without symptoms, there is a low probability of brain injuries that need urgent management, except in elderly patients that require periodic evaluation during the first month due to the risk of chronic bleeding development.

This specific type of injury is called chronic subdural hematoma (SDH). If this specific injury is present, it regularly requires surgical management after 15 to 30 days of the injury.”

Air Force Senior Airman Freddy Toruno positions a service member for a CT scan at Bagram Airfield, Afghanistan’s Craig Joint Theater Hospital. The Army is facing evidence that shoulder-fired weapons cause rarely diagnosed traumatic brain injuries. U.S. Air Force photo by Staff Sgt. Evelyn Chavez

A mild concussion also needs to be taken seriously, in part because it can be difficult to tell exactly how mild it was. A seemingly light blow or a jolt to the head can still hurt the brain directly, and this can change the signals between nerves, which in turn creates the concussion symptoms.

Even after someone begins to recover, they shouldn’t be treated as good to go either. Each person will heal from a concussion differently and at their own pace. Therefore it may be important to find a balance between letting the injured do too much while recovering and doing too little.

However, a general rule is that when recovering from any head wound, cut back on not only physical activities but those that require a lot of concentration. Physical and mental activity can be a problem during recovery.

Unequal pupil size, anisocoria pupil, is potentially a sign of a serious brain injury.

Those recovering from a wound should relax and avoid looking at screens or reading as either can exacerbate the injury. Caffeine should be avoided, especially if it creates anxiety or headaches. After a few days or a week of rest, light activity can begin, such as walks and light work.

More Serious Injuries

One major concern in a world without readily available medical facilities that can treat TBI is that approximately half of those suffering serious TBI may require surgery to remove or repair hematomas (ruptured blood vessels) or contusions (bruised brain tissue).

Unlike treating a burn or cut, or even setting a broken bone, brain surgery is simply not something that can be done without years of training and even then it generally needs proper medical facilities that are equipped for such operations.

TBI in children can be especially troubling and often hard to diagnose.

Since such treatment may not be possible, it is necessary to address the common disabilities that can come from a TBI, including those related to cognition – thinking, memory and reasoning.

Other lasting issues from TBI can include sensory processing, including sight, anxiety, personality changes, aggression, acting out and even social inappropriateness. TBI can result in stupor, an unresponsive state, coma or a complete vegetative state.

For these reasons it is best to protect the head in the times to come. Protecting the brain may be the best way to prep for tomorrow when medical care may not be so readily available.

Brain Buckets

Wear a helmet when doing any construction work or taking part in physical activity where a head injury could occur (such as on a bicycle or motorcycle). Coverage and the level of protection vary by style so be sure the helmet you wear is designed to protect you during your intended activity.

“A helmet acts like the crumple zone in a car, absorbing energy and spreading out the duration of the impact,” explained Ron Szalkowski, director of product development and research collaboration at Team Wendy, a manufacturer of helmets for the military, police and first responders.

“This is like catching an egg and cushioning it by gradually slowing it down,” added Szalkowski. “By doing it gradually, you can prevent the egg from breaking. If it hits an unforgiving surface, it’s forced to slow down immediately, leading to higher forces that exceed the limits of what the egg can handle. Without a helmet, you can easily exceed the forces that the skull and brain can handle.”

Long-Term Effects

A person who suffers a severe brain injury needs to be hospitalized. That may not be possible in the times to come, and TBI can result in long-term problems. A severe brain injury can affect all aspects of a person’s life, including relationships with family and friends, as well as their ability to work, do chores or take part in other normal daily activities.

TBI Can Affect Things Such as:

  • Thinking
  • Memory
  • Learning
  • Coordination and balance
  • Speech, hearing or vision
  • Emotions

Be Alert

Signs and symptoms of a mild head injury:

  • Minor scalp swelling
  • Cut on the scalp
  • Mild headache
  • Vomiting once or twice

 

Signs and Symptoms of a Possibly Serious Head Injury:

  • Loss of consciousness (passing out)
  • Problems with speech
  • Obvious serious head wound
  • Blood or clear fluid from the nose or ear
  • Changes in behavior: agitation, confusion, sleepiness
  • Trouble remembering what happened
  • Dizziness or stumbling
  • Seizure
  • Vomiting more than twice or vomiting hours after the injury
  • Severe or worsening headache

 

Signs and Symptoms of a Concussion:

  • Headache
  • Blurred or double vision
  • Dizziness, balance problems or trouble walking
  • Confusion and saying things that don’t make sense
  • Being slow to answer questions
  • Slurred speech

 

Long-Term Problems Associated with TBI:

  • Trouble focusing
  • Trouble learning or memory problems
  • Headaches that gets worse
  • Sleep problems
  • Mood changes, including feeling sad, easily upset or angered or nervous

 

Editor’s note: A version of this article first appeared in the June, 2020 print issue of American Survival Guide.