Marines in Afghanistan Test New Concussion Care

By Cheryl Pellerin

American Forces Press Service

WASHINGTON, Jan. 27, 2011 – A new concussion care program being fielded by the Marine Corps in Afghanistan is giving psychiatrists, physicians and even chaplains and sergeants a better way to treat those with the No. 1 battle injury, military combat medicine experts said today.

Navy Cmdr. (Dr.) Charles Benson, 1st Marine Expeditionary Force psychiatrist and 1st Marine Division’s deputy surgeon, and Navy Cmdr. (Dr.) Keith Stuessi, director of the Concussion Restoration Care Center at Camp Leatherneck in Afghanistan, spoke with Pentagon reporters in a video teleconference.

The Navy-Marine Corps effort, launched in August and called the Operational Stress Control and Readiness Program, or OSCAR, has two parts, Benson said.

“The first part [includes] psychiatrists and psychologists who we field with the combat team,” Benson explained. “These are organic embedded assets in the division’s regiments and battalions. They live with the troops, train with the troops and get out in the field with them.”

Such an arrangement, he added, “allows the Marines to come forward to the psychologists and psychiatrists [and] kind of breaks down the barriers and allows the [providers] to become very effective at … delivering mental health care.”

The second part of the program offers special training to medical officers, corpsmen, chaplains, religious personnel and key leaders at the sergeant and first sergeant level so they can deliver basic mental health care to troops in harm's way.

“Those folks constantly monitor their Marines,” Benson said, “helping them with simple issues and understanding at what point [a Marine with an injury] needs to be referred back for more comprehensive care.”

Together, the programs “have generated quite a bit of success out here in Afghanistan,” the psychiatrist said, treating concussions and musculoskeletal injuries -- the No. 1 nonbattle injuries of the war.

Stuessi, a sports medicine doctor, described a typical Concussion Restoration Care Center success story.

“I first saw Lance Corporal Smith on Jan. 3, three days after he was medevaced to Bastion Role 3 hospital because of injuries suffered from [ a roadside bomb] blast while on a routine convoy,” he said.

Smith was discharged from the hospital and referred to the outpatient concussion center, where he completed a questionnaire about the blast and his symptoms, and went through a neurologic exam and a neurocognitive test.

“Lance Corporal Smith and I discussed the symptoms -- a constant headache, dizziness, trouble concentrating and sleeping, moderate low-back pain and occasional nightmares, along with repeated thoughts of the blast,” Steussi said. “Over the next 11 days, all these symptoms were addressed by our specialists, who are located under one roof.”

Smith saw a physical therapist, an occupational therapist and a psychologist, and then Steussi used acupuncture to treat Smith’s headaches and insomnia.

Between appointments, Smith stayed with other Marines at a wounded warrior facility.

“During his last visit,” Steussi said, Smith “was completely asymptomatic” and returned to his unit.

Although concussion is a physical injury, Benson said it’s related to mental health.

“When folks have a mild traumatic brain injury, sometimes their symptoms have a psychiatric flavor,” the psychiatrist said. “They might have difficulty sleeping or nightmares and anxiety along with that. And sometimes folks who have straight-up psychiatric symptoms like depression might also have insomnia and problems that look a mild traumatic brain injury.

“There's an awful lot of overlap and symptomatology between the two entities,” he added. “We think it's important to work on these as a team and address both issues at the same time to try to get a Marine back on his feet and heading in the right direction.”

Having psychiatrists and psychologists embedded in regiments and battalions gives troops who might not naturally turn to a mental health provider a range of ways to seek help, Benson said.

“Most of the best OSCAR and OSCAR Extender Program outreach happens when it's not really a formal sort of thing,” he added. “It's like when you're sitting at breakfast eating your toast and a Marine sits across from you and says, ‘Hey, Doc, you got a moment?’ And then you start chit-chatting.

“Or you might be waiting in line or something and they know you because they see you out there in the field,” he continued. “They understand that you can relate to what they're going through, and they feel more comfortable coming to chat with you.”

Ultimately, Benson added, the program should help to reduce the stigma attached to seeking mental health care.

“When you're in combat, when you're deployed, you're going to have feelings,” he said. “Things are going to come up. It's best if you talk about them and seek out help.”

Steussi said center providers have treated and returned to full duty about 320 concussion patients, collecting data on each case along the way.

“We're in the process of reviewing the data so that in the future we can better treat Marines and sailors,” he added, “and use the information to [develop] policies for treatment here, out at [forward operating bases] and in the field.”