I Cogitate

The hidden wounds of the Iraq war
By Ronald Glasser
San Jose Mercury News
4/15/2007

"We can save you. But you might not be what you were." - Neurosurgeon, Combat support hospital, Balad, Iraq

This is the new physics of war. Three 155mm shells linked together and combined with 100 pounds of Semtex plastic explosive, then covered by canisters of butane or barrels of gasoline, can up-end a 70-ton tank, destroy a Humvee or blow an engine block through the hood of a truck. Those deadly ingredients form the signature weapon of the war in Iraq: improvised explosive devices, known by anybody who watches the news as IEDs.

Some of the impact of these roadside bombs is brutally clear. Troops are maimed by projectiles, poisoned by clouds of bacteria-laced debris and burned by post-blast flames. But the IEDs have added a new dimension to battlefield injuries: injuries and even deaths among troops who have no external signs of trauma but whose brains have been severely damaged. Iraq has brought back one of the worst afflictions of World War I trench warfare: shell shock. The brain of a soldier exposed to a roadside bomb is shocked, truly.

About 1,800 U.S. service members, according to the Department of Veterans Affairs, are now suffering from traumatic brain injuries caused by penetrating wounds. But neurologists worry that hundreds of thousands more - at least 30 percent of the troops who have engaged in active combat for four months or longer in Iraq and Afghanistan - are at risk of potentially disabling neurological disorders from the blast waves of IEDs and mortars, without suffering a scratch.

For the first time, the U.S. military is treating more head injuries than chest or abdominal wounds, and it is ill-equipped to do so. According to a July 2005 estimate from Walter Reed Army Medical Center, two-thirds of all soldiers wounded in Iraq who don't immediately return to duty have traumatic brain injuries.

Here's why IEDS carry such hidden danger. The detonation of any powerful explosive generates a blast wave of high pressure that spreads out at 1,600 feet per second from the point of explosion and travels hundreds of yards. The lethal blast wave is a two-part assault that rattles the brain against the skull. The initial shock wave of high pressure is followed closely by the "secondary wind:" a huge volume of displaced air flooding back into the area, again under high pressure. No helmet or armor can defend against such a massive wave front.

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