Colonel Grimes, thank you for that kind introduction, and for inviting me here today.
My thanks also to Dr. Lu Beck, VA’s Chief of Rehabilitation Services, and to Dr. Dave Chandler and their staff, for the important work they do for us and for Veterans.
Dr. Ann McKee, Director of Neuropathology at the Bedford, Massachusetts, VA Medical Center—many thanks for an illuminating visit to your research lab last Thursday.
Dr. Charles Rice and Rear Admiral Jeffries, welcome.
Other DoD and VA colleagues, fellow Veterans, distinguished guests, ladies and gentlemen:
I am honored to be here to address this talented group of brain injury experts. Let me preface my remarks today with an admission I often use at VA, when I remind my colleagues there that I didn’t grow up in VA and I’m not a clinician. My instincts aren’t very good—dots don’t connect for me as readily in health care as they do elsewhere in the military profession—so you’ll have to accept some fundamental ignorance on my part about things you know far better. Jamie Grimes’ invitation to address you today, while welcomed, is not without challenge.
I’m sure the symptoms of brain trauma of varying severity have been around me all my life. I recall soldiers coming home from World War II behaving differently—oddly. My own early experiences in athletics, when “getting your bell rung” was part of sports; boxing in college, where more bells were rung; and coping with the physical demands of 38 years in uniform--certainly in Vietnam, where a helicopter crash knocked me unconscious for some 16 hours and, again, when an anti-personnel landmine flipped me into the air, landing headfirst, hard. Beyond the obvious physical injuries, I recall lingering headaches, double vision, nausea—a general feeling of being out of sorts. None of us had ever heard of TBI or PTSD. “Shake it off; get back in there,” was the usual refrain.
Well, even today, that’s the way most young people think about getting their bells rung, especially where visible injury is not evident. They are at the stage in life where they are invincible; “10-feet-tall-and-bulletproof,” as Travis Tritt would say. Any commander asking a youngster “how are things going?,” will almost always be told, “Great, sir!” Or “Great, ma’am.” And, unless we pursue asking what that really means, “great” could be something much less. Troops may be going back to barracks or tents where the light bulbs seem overly bright or others’ quiet conversations are irritatingly loud, or headaches, dizziness, insomnia, and unsteadiness, even when just standing, are inconveniences that could worsen over time.
“Great, sir!” may, in fact, be the wrong answer, maybe even a potentially fatal one—despite the sense of invincibility that characterizes most young Americans, especially young Americans serving in the world’s best military. Who of them is going to complain that they are injured, when there are no outward manifestations of injury? Or declare that they need help, feel vulnerable, or “just can’t hang,” in their vernacular?
I know a little more about brain injury today than I did two weeks ago for two reasons: for one, I visited Dr. Ann McKee at her clinic in Bedford. Dr. McKee will be making a presentation at this conference, and I had a chance to hear about her research with Robert Cantu, Robert Stern, and Chris Nowinski in brain trauma. I don’t think I suffer any lingering effects from my collisions with the immovable, “yet,” as Dr. McKee might point out. But there is something important in her study about the effects of repeated trauma to the brain over time, even when the trauma may not involve knock-out concussions.
It would be important to know whether repeated moderate blows to the head could cause deterioration over time in a profession where paratroopers with hundreds of jumps invariably strike the ground hard from time to time. And occupants of armored vehicles occasionally have their heads smacked hard against metal walls and ceilings—not only during mine and IED blasts, but also in the course of normal operations when their armored vehicles jump and buck and slam into potholes traveling across uneven terrain, or when hatches come loose, striking someone’s protective headgear.
There is so much more that we don’t know. And that is why Ann’s work, that of her fellow researchers, and the research work of many others in this room is so very significant. It is not enough to know after folks have expired that they suffered brain deterioration due to trauma. We need to know the likelihood of that kind of deterioration when the injury occurs. Maybe then we will find ways of not only treating and rehabilitating the injured, but also make more and wiser investments in preventing them.
The second event which expanded my knowledge about brain injuries was a visit, last Friday, by Dr. Lu Beck and Dr. Dave Chandler in preparation for my visit here today. They shared with me some of DVBIC’s printed materials to aid in identifying potential TBI cases early on--for example, the M.A.C.E [Military Acute Concussion Evaluation] card, carried by medics, to enable early detection and tracking of TBI injuries. You either believe in the efficacy of medicine or you don’t. I happen to believe in it. Early detection, diagnosis, treatment, and rehabilitation, if necessary, help people recover from injury or illness. If you don’t believe in the efficacy of medicine, you’ll follow some other regimen.
Having said that, let us be clear about the reactive nature of the work you are in. Senator Dan Inouye tells me that no double amputees survived in his regiment during World War II. A comment like this underscores how far we have come in protecting the chest cavity and vital organs against lethal wounds. That is my experience as well. After more than 38 years in uniform, I saw the drastic improvements in protection and treatment—battlefield combat lifesaving, medical evacuation, emergency surgical techniques. Many more of our combatants, as you know, are surviving potentially lethal injuries today than survived even 10 years ago. What was thought unimaginable 40 years ago is common practice today.
From the first Gulf War to the wars in Southwest Asia, the advance of TBI-related care has been on a steeply-rising trend line as new technologies, new methods of early treatment, and aggressive post-recovery therapies made their way from research to practice. That trend line began with DVBIC’s congressional directive in 1992 to integrate specialized TBI care, research, and education across military and Veteran health care systems.
VA’s four Polytrauma Rehabilitation Centers are the descendents of DVBIC’s 1992 congressional mandate. We share a symbiotic relationship. Over the intervening 18 years, we have seen our collaboration thrive, resulting in:
VA and DoD share a common objective when it comes to the well-being of our young men and women who are handed the in-extremis missions—and in recognizing the health care burdens their families often carry. All of us here at this conference are part of, and affect, the continuum of care we provide.
I hope everyone here saw the front page USA Today article at the end of July, chronicling the success of VA’s four “emerging consciousness” programs in our polytrauma centers. Through innovative care, tripling of professional staff from 78 to 255 in the last six years, more resources, and allowing families unfettered access as partners in treating their loved ones, the four polytrauma centers have brought nearly 70 percent of these patients back to consciousness. That rate is "certainly above the national norm in the private sector," according to the director of brain injury rehabilitation at the Kessler Institute for Rehabilitation in New Jersey.
The director of the Spaulding Rehabilitation Center of Harvard’s medical school added that VA is in an “excellent position to further advance the science” of helping those with these devastating injuries—both service members and civilians.
That’s high praise; and those accolades rightfully belong to all of you in this room. Remember, I said we are in a symbiotic relationship; these gains belong to both VA and DoD. But like every great unit and organization, we’re constantly striving to do more, learn more, and make our programs better. It is important to appreciate the need to establish and integrate research and clinical goals across DoD and VA—goals that meet the demand for services and care, transition from DoD to VA, and long-term quality support to Veterans and their families. DVBIC provides an effective model for achieving this.
To illustrate the importance of that model, let me share with you the story of one young Soldier’s fight to overcome the terrible trauma of TBI, the story of a young man President Obama related at the annual Disabled American Veterans’ conference earlier this month.
On October 1st of 2009, a 300-pound IED—improvised explosive device—targeted a patrol of nine Army Rangers of the 1st Battalion, 75th Ranger Regiment on the outskirts of Kandahar, Afghanistan. All were casualties. One Ranger was killed, another suffered a traumatic amputation of his leg, and a third—Ranger Cory Remsburg—was blown into a nearby canal, the right side of his head shattered and caved in.
Following medical evacuation and six surgeries at military hospitals in Afghanistan, Germany, and Bethesda, Cory arrived in November at the VA Medical Center in Tampa. He was comatose—in a state doctors described as vegetative. The odds for a recovery, any recovery, were long.
But Cory, his family, VA therapists, doctors, and nurses never gave up; they rallied to his side, working his limbs and massaging his body using a wide variety of medications, aromas, television—anything which might stimulate his senses—everything they could think of to bring him to consciousness. Some of you here know this—because you did it.
For long days and weeks, nothing; but three months after his injury, doctors recognized that Cory had regained consciousness. Through sheer determination on his part, mirrored by the unwavering efforts of those who love and care for him, his progress has been agonizingly slow, but steady. He communicated first through a computer keyboard, but has now, slowly, regained his ability to speak. In June, he returned for a visit to Hunter Army Airfield in Savannah, home of the 1st Ranger Battalion.
As President Obama recounted, Cory is a truly-inspiring American, just what we’d expect of a Ranger Staff Sergeant. When someone at the VA hospital told him, “Cory, some day you’re going to walk out of here,” he replied, “No. I’m going to run out of here.”
Cory is a fighter—a Ranger, a warrior, and a Veteran. A Soldier who was wounded on his tenth—his tenth—deployment since 11 September 2001. He is also, due to the efforts of many of you, one of VA’s 70-percenters—one of those with severe, traumatic brain injury, who VA doctors and therapists, along with Cory’s fighting spirit and his family’s love, brought back from the darkness.
Staff Sergeant Cory Remsburg embodies the fighting spirit that has made our Nation great. Rangers lead the way. And no matter the service, I think we can all relate to the importance of the words in the Soldier’s Creed:
Staff Sergeant Cory Remsburg’s life—from his ten deployments, to his rescue by other Rangers, to his fight for life—epitomizes that creed. He will not give up. Period. And that creed has meaning to all of us, as well.
VA and DoD health care professionals will not give up on any service member or Veteran who needs our very best care. That promise defines DVBIC’s mission—a mission that is fueled by the combined energies of DoD and VA health care professionals who are dedicated to helping all TBI victims recover their lives, and discover their futures.
God bless the men and women who serve and have served in harm’s way. And may God continue to bless this wonderful country of ours. Thank you.