U.S. soldiers and journalists inspect the rubble at a site of Iranian bombing, in Ain al-Asad air base, Anbar, Iraq, Monday, Jan. 13, 2020.

U.S. soldiers and journalists inspect the rubble at a site of Iranian bombing, in Ain al-Asad air base, Anbar, Iraq, Monday, Jan. 13, 2020. AP / Qassim Abdul-Zahra

Pentagon Defends Handling Of Traumatic Brain Injuries In Iranian Attack

TBI symptoms are often “nonspecific,” the Joint Staff surgeon said.

The Pentagon is defending its handling of troops injured during the Jan. 7 Iranian attack on Ain Al-Asad airbase in Iraq, 110 of whom have since been diagnosed with mild traumatic brain injuries.

The symptoms of traumatic brain injury, or TBI, are often “nonspecific,” according to Brig. Gen. Paul Friedrichs, the Joint Staff surgeon, who is a neurological surgeon by training. Those symptoms can include everything from headaches to dizziness, memory problems, balance problems, difficulty concentrating or irritability. 

“A lot of people have said, ‘Why didn’t we immediately identify everybody with a traumatic brain injury? Because the signs sometimes are fairly nonspecific,” Friedrichs told reporters at the Pentagon on Monday afternoon. 

And although some troops were automatically screened under Pentagon protocol — including those within 50 meters of the blast and those who had been diagnosed with a previous traumatic brain injury — some troops didn’t report experiencing symptoms until later.

Related: As Toll Mounts, Trump Downplays Injuries Suffered in Iranian Attack

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“If you’re 18, 19, or 20 years old, even though we’ve trained everybody who deploys downrange on what to look for, it’s quite common that we’ll have folks who will say, ‘I just was blasted; of course I’m not going to feel quite right; I’m just going to ride this out for a couple of days,’” Friedrichs said. “And then they come in, several days or weeks after the fact.”

The military’s diagnosis and disclosure of the injured troops has been under fierce scrutiny, in part due to a delay in an official acknowledgement that Americans had been injured in the attack. President Trump initially claimed that there were no casualties in the attack, and after the first tranche of injured service-members was revealed a week later, downplayed the severity of those injuries, calling them “headaches” and “not serious.”

Trump’s original claim that “all of our soldiers are safe” came as the United States and Iran were trying to de-escalate the tense situation, and the decision to downplay troop injuries might have been part of that signaling. Almost immediately following the attack, Trump tweeted, “All is well!” 

But the toll of troops diagnosed with mild traumatic brain injury, or TBI, has continued to mount. On Friday, the Pentagon released an updated number: 110 diagnoses, up one from the previous report. Seventy percent of those troops have since returned to duty, while 35 were sent to Germany for further evaluation. Some of those were sent home to the United States to receive continuing treatment. 

"What we don't want to do is say, 'You've had your bell rung; go get back in the fight,’” Friedrichs said. 

Friedrichs also defended the military’s tools and procedures for diagnosing TBIs. The Military Acute Concussion Evaluation, or MACE tool — last updated in 2016 and now known as MACE II — includes a physical exam, listening to the patient and a series of memory tests. If an individual tests positive for a TBI, then there is a 24 hour rest period and the MACE II test is repeated. 

“We purposely built in a rest period to reevaluate people to see if whatever people were complaining of goes away,” he said — adding that this would also explain why diagnoses were reported on a rolling basis. 

Friedrichs underscored the severity of the Iranian attack, calling it “remarkable” that there were no acute injuries from the ballistic missile attack. 

“Theater ballistic missiles are really big munitions and the fact that nobody had a physical injury is frankly extraordinary,” he said.