The Golden Hour (Scene 1)
Lesson 1: What is traumatic brain injury?
August 2012
Soldiers and TBI: Why a concussion isn’t just a simple bump on the head
Injuries are not always obvious, and many times, not even to the victim. Explosions, mortars, and gunfire
are potentially common occurrences for a soldier. In battle situations, rushes of adrenaline and the drive
to survive the conflict can make some injuries relatively unnoticed until much later. Not realizing the full
impact of a particular incident, the injury could be left untreated for long periods of time which could
increase the risk of serious side effects. Most of us do not fear the explosion of a rocket in our daily lives,
but relatively common events such as car accidents and sports accidents that result in brain injury can
still have similar serious negative consequences for a person’s quality of life.
Staff Sgt. Andrew Cooper* had become accustomed to the dangers of his daily life as a tank
commander. In July 2007, an enemy projectile suddenly struck the side of the tank. Cooper instructed
the driver to return to base immediately. It wasn’t until later that Cooper became woozy and realized
that he didn’t remember most of the incident. At first Cooper didn’t think much of hitting his head
during the blast and chalked up the light headedness and nausea he was experiencing to the adrenaline
rush. The next day, however, his symptoms began to worsen. Cooper continued to vomit and had a
massive headache in the morning. His squad members noted that he looked intoxicated despite
Cooper’s repeated claims that he felt normal. His superior sent him to the medics. After a battery of
cognitive tests, Cooper was medically evacuated out of the combat zone and began a path of healing
which continues to this day.
Cooper was diagnosed with a traumatic brain injury (TBI) almost immediately. During his examination,
Cooper was tested using the Glasgow Coma Scale. The Glasgow Coma Scale assesses the Verbal, Motor,
and Eye response of the patient following an injury. Although he could respond to verbal commands, his
inability to remember the damaging incident and his intoxicated appearance indicated possible reduced
cognitive stability and amnesia. He also showed reduced eye response to a light pen. The doctors used
these examinations to total a Glasgow Coma Scale (GCS) of 13. The GCS is a useful diagnostic tool in
assessing traumatic brain injury. Though loss of consciousness is often a key identifying factor in TBI,
disruption of brain function can also occur without loss of consciousness. It is important to note that
while the incident that causes the injury will vary greatly, visible head injuries may or may not be
present. Other signs are needed to accurately recognize a TBI victim. Symptoms such as brief confusion,
losing track of time, and a dazed state of mind are not uncommon. Patients like Cooper could also
exhibit odd behavior such as having trouble following everyday conversations and following basic
commands. They may not always be physically paralyzed, “but there is a paralysis in mental activities”
Cooper’s doctor said. Injuries such as Cooper’s are common in the army and the conditions of battle can
often make diagnosing the injury challenging. Once Cooper returned to his home, he had difficulty with
many everyday activities and had to rely on his wife to assist him with many routines. Due to his
frequent headaches, his wife would dim the lights around the house and would have to help him
remember nearly everything.
Doctors at the Army Medical Center started Cooper on extensive regimens of cognitive and memory
exercises. These activities, such as playing video games, helped Cooper improve his coordination and
cognitive skills. The injury left Cooper’s brain in many ways disabled. Although he was capable of many
cognitive functions, they required more effort than usual and he would often come up short. A major
part of his rehabilitation was exercising his brain which, similar to a muscle, needs to regain and
maintain its strength. Many individuals diagnosed with traumatic brain injury are medically discharged
from service. Cooper knew he wanted to stay in the army, but he knew he would need to recover before
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The Golden Hour (Scene 1)
Lesson 1: What is traumatic brain injury?
August 2012
he could take on the duties he once held. “I didn’t want to get out. I knew I could recover and I told
myself I was going to recover.”
Cooper now serves as a noncommissioned officer for the Warrior Transition Brigade where he schedules
soldiers for classes to assist with their career field and training. He uses a system of sticky notes and todo lists to aid in his daily responsibilities. After his time with the Warrior Transition Brigade is complete
and despite the experience which caused his condition, Cooper plans to return to his former position as
a tanker. He is aware that his previous injury makes him susceptible to more serious and even fatal
consequences from similar accidents. He has since been cleared by his doctors and is anxious to return
to combat. “Its my job. I haven’t been done wrong by the Army doctors and I trust their word. If they say
I can go back, I want to go back.” The key in such cases is early detection. If patients wait too long, there
can be severe long-term damage to the brain and the way it functions. Fortunately, Cooper’s injury was
recognized almost immediately and treatment was sought soon after. It is important for soldiers such as
Cooper to recognize the symptoms of a traumatic brain injury not only in fellow soldiers, but also in
themselves.
*Names changed for privacy.
Article adapted from
Pariante, Joy. (2010, April 1). Soldiers and TBI: Why a concussion isn’t just a simple bump on the head.
Fort Hood Sentinel. Retrieved from http://www.forthoodsentinel.com/
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