Why a TBI is so dangerous — and how to treat it - We Are The Mighty
MIGHTY CULTURE

Why a TBI is so dangerous — and how to treat it

Brain injuries are the signature wounds of the wars in Afghanistan and Iraq, with more than 380,000 service members experiencing them between 2001 and 2017, according to the Department of Defense. Traumatic brain injuries (TBI) can have devastating effects on those who experience them, such as vomiting, seizures, speech disorders, and aggression. Long after initial impact, the resulting injuries can leave sufferers with invisible wounds that are tough to pinpoint or treat.


According to the Military Health System guidelines, a TBI is a traumatically induced structural injury or physiological disruption of brain function, the result of an external force. It’s indicated by an altered mental state, such as disorientation or a decrease in cognitive functions, as well any loss of memory for events immediately before or after the injury, or the loss of or a decreased level of consciousness.

Equally challenging for medical providers is the stigma victims often feel when it comes to seeking help. But researchers say awareness and advances in the DoD’s treatment and prevention strategies have changed for the better the way patients recover.

Why a TBI is so dangerous — and how to treat it

“There has been an increase of awareness about TBI, and that has made a great difference in early identification and intervention. Even in the past few years, we’ve seen a greater willingness to seek treatment for both TBI and psychological health concerns,” said Dr. Louis French, deputy director of operations and a clinical psychologist at the National Intrepid Center of Excellence (NICoE) located in Bethesda, Maryland.

Opened in 2010, NICoE helps active duty members, reservists, veterans, retirees, and their families manage TBIs and other associated conditions while providing diagnostic evaluation, comprehensive treatment planning, outpatient clinical care, and TBI research and education.

According to French, understanding the relationship between the mind and the brain is important because psychological and emotional health can influence TBI recovery.

A TBI can impact a person’s physical, cognitive, and behavioral or emotional functions. It can cause a variety of symptoms, including headache, nausea, dizziness, difficulty with concentration, memory, and language, and feelings of depression and anxiety.

“We continue to grow our understanding of the various factors that go into a person’s recovery from TBI, including physical, emotional, sensory, cognitive and other aspects,” said French. “Family involvement is also now recognized as an important part of the recovery process, and for those who may have complicated recoveries.”

At the NICoE, patients and their families have access to traditional medical specialties like primary care, advanced neurology and neuropsychology, as well as complementary holistic approaches, including wellness and creative arts therapy.

Why a TBI is so dangerous — and how to treat it

Alyson Rhodes, a yoga therapist, leads patients through the rest pose portion of a therapeutic yoga session, Dec. 11, 2017.

One of many reasons the center was created, said Capt. Walter Greenhalgh, director of NICoE, is to provide support to patients and their families.

“NICoE treatment programs are designed to encourage family-member involvement in the patient care plan by attending appointments and participating in programs like family therapy, family education classes, and Spouse and Caregiver Support groups. Our social workers provide education and skills training for all family members and connect them with resources to help them cope as a family unit,” Greenhalgh explained.

Group therapy for those coping with similar injuries can also show patients they aren’t alone and allow families the opportunity to interact with other family members.

Although TBIs are widely viewed as combat injuries, service members can still be at risk during day-to-day activities. Research conducted by the Defense and Veterans Brain Injury Center shows TBIs are more commonly the result of operational training, falls and motor vehicle accidents.

“TBI is not just a military injury. It’s easy to forget that it was only 10 years ago that we wrote the first in-theater guidelines for TBI, and now we have standardized assessment and treatment protocols across the entire Defense Department,” said French.

Why a TBI is so dangerous — and how to treat it

The National Intrepid Center of Excellence, or NICoE, a directorate of Walter Reed National Military Medical Center in Bethesda, Maryland.

The majority of traumatic brain injuries — 82 percent — are classified as mild TBIs or concussions. Mild TBIs:

– Can leave sufferers in a confused or disoriented state for less than 24 hours
– Can cause loss of consciousness for up to 30 minutes
– May result in memory loss lasting less than 24 hours

Moderate TBIs:

– Can create a confused or disorientated state that lasts more than 24 hours
– Can cause loss of consciousness for more than 30 minutes, but less than 24 hours
– May result in memory loss lasting more than 24 hours but less than seven days
– Can appear to be a mild TBI, but with abnormal CT scan results

Severe TBIs:

– Can create a confused or disoriented state that lasts more than 24 hours
– Can cause loss of consciousness for more than 24 hours
– May result in memory loss for more than seven days

A penetrating TBI, or an open head injury, is the most severe type of TBI:

– The scalp, skull and dura mater (the outer membrane encasing the brain and spinal cord) are penetrated by a foreign object.
– Penetrating injuries can be caused by high-velocity projectiles.
– Objects of lower velocity, such as knives or bone fragments from a skull fracture, can also be driven into the brain.

The current definition of TBI was updated in 2015 to be consistent with military and civilian guidelines, and a later review showed that many previously “unclassifiable” cases were likely moderate TBIs.

“Having standardized assessment and treatment guidelines pushed out to an entire military health system and being able to track people through an integrated medical record is amazing,” said French. “Then you have the development of places like NICoE and the Intrepid Spirit Centers that provide intensive, integrative treatment.

“The military and academia are working hand-in-hand to answer questions and improve assessment and care. There are a lot of things that have been done in support of TBI advancement — any of my civilian colleagues look at what the Defense Department achieved in this amount of time, and it’s phenomenal.”

This article originally appeared on All Hands Magazine. Follow @AllHandsMag on Twitter.

MIGHTY TRENDING

Missile scare at Ramstein Air Base: ‘Hasn’t 2020 been hard enough?’

On January 13, 2018, a ballistic missile alert went out across televisions, radios, and cellphones in the state of Hawaii. The message went out at 0807 local time and civil defense outdoor warning sirens went off across the islands. However, the alert turned out to be an accident. On December 12, 2020, Ramstein Air Base had a similar alert.

Why a TBI is so dangerous — and how to treat it
The alert spooked more than a few folks (Public Domain)

Ramstein Air Base personnel were alerted to a real world inbound missile strike and received an Alarm Red MOPP 4 notification. “Take immediate action!” The alert read. “For further information refer to Airman’s manual.” While the alert certainly put a lot of people in the Kaiserslautern Military Community on edge, the “All Clear” was issued two minutes later. It is unknown what triggered the warning system’s mass alert. However, the alert was later attributed to an exercise.

“Attention Team Ramstein, today, the Ramstein Air Base Command Post was notified via an alert notification system of a real-world missile launch in the European theater. The Command Post followed proper procedure and provided timely and accurate notifications to personnel in the Kaiserslautern Military Community. The missile launch was then assessed to be part of a training exercise and not a threat to the KMC area. The situation is all clear. We’d like to thank our Command Post members for their quick response to ensure our people stay informed so they can take the proper safety precautions.”

Despite the all clear and the message from the Command Post, personnel in the KMC area remain on edge. “That’s not the kind of thing you joke about,” one anonymous service member told WATM. “Hasn’t 2020 been hard enough?” Neither USEUCOM nor Ramstein Air Base have released an official statement regarding the incident.

The erroneous 2018 Hawaii missile alert was corrected 38 minutes after it went out. Following the incident, the FCC and Hawaii House of Representatives conducted investigations into the cause of the event. These resulted in the resignation of the state’s emergency management administrator. Whether or not the alert at Ramstein was a training exercise, the reaction of the KMC community was very real.

Why a TBI is so dangerous — and how to treat it
(U.S. Air Force)
MIGHTY HISTORY

This miniatures game helps you re-fight World War II

World War II has always been a popular subject for wargamers. On land, sea, or air, this conflict has an extensive library of options, whether it be a board game, a computer game, or miniatures rules. But all games are not equal. There are also tradeoffs – each type of game has its pros and cons.

One miniatures game for the World War II era (and about a decade beyond) is Command at Sea, part of the Admiralty Trilogy of wargames designed by Larry Bond. Bond’s most famous wargame, Harpoon, is notable for its use by author Tom Clancy in the development of Red Storm Rising.


Command at Sea is now in its fourth edition since 1994. This version has been harmonized so that its simulations are in the same format as the other games in the Admiralty Trilogy, Harpoon and Fear God and Dreadnought. This means that those who have these games could cover a war from 1989 to 2018 with very little difficulty.

Why a TBI is so dangerous — and how to treat it

Can you, as America, did, turn back the Japanese in the Pacific, despite having power ships like the heavy cruiser Takao and the battleship Kirishima?

(Imperial Japanese Navy photo)

A substantial number of additional modules, supporting every major combatant and theater of the war, are available. One that came with earlier versions of the game is The Rising Sun in the Pacific, which covers the first half of the Second World War in the Pacific Theater, where pivotal battles like the Battle of the Coral Sea, the Battle of Midway, and the Naval Battle of Guadalcanal can be re-fought on one’s own tabletop, along with possible battles that could have taken place had history gone differently.

Why a TBI is so dangerous — and how to treat it

USS Enterprise (CV 6) preparing to launch planes against the Japanese.

(US Navy photo)

Other modules include American Fleets, which covers just about every ship class and aircraft the United States used during the war, and a few, like the Montana-class battleships, which didn’t make it to the fleet. Another module is Steel Typhoon, which covers the second half of World War II in the Pacific with 36 scenarios of both historical and hypothetical battles. The system doesn’t just cover World War II. The Spanish Civil War, fought before World War II was seen as inevitable is covered in a module.

Why a TBI is so dangerous — and how to treat it

With Command at Sea, USS Tuscaloosa (CA 37) could have a very different service career during World War II.

(US Navy photo)

Since this is a set of miniature rules, it has some advantages over computer simulations. The online store Wargamevault.com has this game and the modules in both downloadable PDF and hard-copy versions.

Articles

These 3 soldiers fought their way back to the front lines after losing legs

Typically, an amputation ends a military career. For a long time, most any level of amputation was considered to make a service member unfit for combat. As of last summer, only 57 amputees had returned to conflict zones and most of those stayed at a desk.


These three men wanted to get back into the fight.

1. The Ranger who swore he’d still be a squad leader

Why a TBI is so dangerous — and how to treat it
Photo: US Army Special Operations Command

Sgt. 1st Class Joseph Kapacziewski was in an armored vehicle when insurgents threw a grenade into it. Kapacziewski survived the blast with serious injuries. After months of surgeries and casts, he attempted to walk on his right leg again and heard the pins holding it together snap. Soon after, he asked doctors to remove it.

Also, watch: Bryan Anderson’s Amazing Story Showcased in ‘American Sniper’ 

Over the months and years that followed, Kapacziewski (a.k.a. “Joe Kap”) relearned how to do the basic tasks required of Rangers . He ran, rucked, parachuted, and completed Army drills with his prosthetic leg. Since his amputation, he has conducted four combat deployments and even earned an Army Commendation Medal for pulling an injured soldier 75 yards during a firefight.

2. The paratrooper who led an airborne platoon with a prosthetic

Why a TBI is so dangerous — and how to treat it
Photo: US Navy Lt. j.g. Bryan Mitchell

1st Lt. Josh Pitcher finished relieving himself on the side of the road, closed his fly, and heard the loud pop of a small roadside bomb. Two days later, he was in a hospital in Germany, promising to return to combat despite losing his left leg beneath the knee. Before he could even try and return to active duty, Pitcher had to kick a pill and drinking habit he got trying to deal with the pain after his surgeries. But, he learned how to do his old job with his new leg. Less than two years after his injury, he returned with his unit, the 4th Brigade Combat Team, 82nd Airborne Division, to Afghanistan. A few months later, he took over a 21-man platoon and led them for the rest of the deployment, most of it trudging through the mountains in the northern regions of the country .

3. The captain who calmly reported his own double amputation

Why a TBI is so dangerous — and how to treat it
Photo: US Army SGT Joe Padula

When then-1st Lt. Daniel Luckett’s vehicle was hit by an IED in Iraq in 2008, a squad leader called up to ask if everything was all right. Luckett calmly responded, “Negative. My feet are gone.” Two years later, Capt. Luckett was with the 101st Airborne Division again; this time in Afghanistan. He uses a small prosthetic to assist what remains of his right leg. A much larger one serves as his left. His second day with his first prosthetic, he attempted to walk away with the leg. Doctors tried to get it back, but Luckett convinced them to let him keep it. He would go on to earn the Expert Infantry Badge during his efforts to prove he was still an asset. After successfully earning the award, the soldier was promoted to captain and allowed to deploy with his unit as part of the Afghan surge.

MIGHTY TRENDING

This soldier was killed supporting freedom in Afghanistan

The Department of Defense announced today the death of a soldier who was supporting Operation Freedom’s Sentinel.


Why a TBI is so dangerous — and how to treat it
Soldiers of Delta Company, 3d US Infantry Regiment (The Old Guard), finish folding a flag in Arlington National Cemetery, Va., April 17, 2013. Army photo by Sgt. Jose A. Torres Jr.

Sgt. First Class Stephen B. Cribben, 33, of Simi Valley, California, died Nov. 4 in Logar Province, Afghanistan as a result of wounds sustained while engaged in combat operations. He was assigned to 2d Battalion, 10th Special Forces Group, Fort Carson, Colorado. The incident is under investigation.

MIGHTY TACTICAL

These are the Marines’ new Night Vision Devices

An updated helmet-mounted night vision system is beginning to make its way to infantry units. Marine Corps Systems Command accelerated the acquisition of about 1,300 Squad Binocular Night Vision Goggles using existing Defense Logistics Agency contracts.

“We have employed a bridge capability to give Marines the best gear right now available in the commercial marketplace,” said Lt. Col. Tim Hough, program manager for Infantry Weapons. “A final procurement solution will allow a larger pool of our industry partners to bid on the program.”


Army/Navy Portable Visual Search devices, or AN/PVS, have been employed by the military since at least the 1990’s and upgraded with next-generation systems as funding and technology became available.

Why a TBI is so dangerous — and how to treat it

Marines took delivery of the Squad Binocular Night Vision Goggles during new equipment training in December 2018 at Camp Lejeune, North Carolina.

(Photo by Joseph Neigh)

The move to the SNBVG is expected to enhance the infantry’s lethality and situational awareness in reduced visibility. It combines two systems: a binocular night vision device and an enhanced clip-on thermal imager.

“It’s a little bit lighter than the current system, and gives Marines better depth perception when they are performing movements,” said Joe Blackstone, Optics team lead at MCSC.

Marines took delivery of the equipment and learned how to use them in December 2018 at Camp Lejeune, North Carolina. Known as NET, the new equipment training entails teaching Marines about the operations, characteristics, maintenance and use of the new devices.

“The lethality that it’ll bring is exponential [sic],” said Cpl. Zachary Zapata, a Marine who participated in the training. “With these new [BNVGs], having the ability to not only use thermal optics along with it, but just the entire depth perception and speed that we can operate in is going to significantly increase, as opposed to what we were able to do in the past.”

Why a TBI is so dangerous — and how to treat it

(U.S. Marine Corps photo by Cpl. Aaron James B. Vinculado)

The initial buy and follow-on procurement is being funded with Marine Corps dollars as prioritized by the Department of Defense Close Combat Lethality Task Force, which concentrates on the squad-level infantry and is aimed at ensuring close combat overmatch against pacing threats. The SBNVG acquisition strategy is to procure the devices incrementally and concurrently as the Corps looks toward future technologies.

“Right now, we are participating with the Army on their next generation night vision systems, both the Enhanced Night Vision Device-Binocular and Integrated Visual Augmentation System Programs,” Hough said. “We are eager to see the maturation of these capabilities for adoption to improve the effectiveness of our Marines.”

The program office plans on releasing a final request for proposals to procure an estimated 16,000 additional systems on the basis of full and open competition. According to program officials, a draft request for proposals was posted to the Federal Business Opportunities website in mid-November 2018, and closed on Dec. 19, 2018. The Government is currently adjudicating comments and anticipates release of a final RFP in the near future.

Additional fielding of the systems is planned for September 2019. While the devices may eventually make their way to the entire Ground Combat Element, for now the first priority is given to the Marine Rifle Squad, program officials said.

“This program office is committed to bolstering the combat lethality, survivability, resilience and readiness of the GCE,” said Hough.

This article originally appeared on the United States Marine Corps. Follow @USMC on Twitter.

MIGHTY TRENDING

This treatment for wounded warriors is ‘tubular’

After losing his arm and leg in battle, a Hawaiian soldier being treated at the Naval Medical Center San Diego told his doctors that more than anything else, he wanted to surf again.


Navy Seaman Emily Wallace reacts to a moment free from her severe pain during a surf therapy session for Naval Medical Center San Diego patients in Del Mar, Calif., Sept. 14, 2017. The medically appointed surf therapy helps her to manage her pain and provides her with a reprieve from chronic pain without medications. DoD photo by EJ Hersom

Almost 10 years later, the hospital’s surfing clinic staff has assisted more than 1,500 wounded, ill and injured service members from all service branches in their recovery through surfing.

“I remember at the time, I told him we’re going to go surfing but I had no idea how we’re going to go, with him missing an arm and a leg,” said Betty Michalewicz-Kragh, surf therapy program manager and exercise physiologist with the Health and Wellness department at the medical center, also known as “Balboa.”

Michalewicz-Kragh said she looked for ideas on the internet and eventually called a Brazilian above-the-knee amputee who came to San Diego and assisted Michalewicz-Kragh in training the soldier for five weeks.

The patient started surfing. “And as a result of him going surfing, many other wounded warriors have gone surfing, and it’s been an amazing journey,” she said.

Why a TBI is so dangerous — and how to treat it
Volunteers attend a briefing for the Naval Medical Center San Diego surf therapy session in Del Mar, Calif., Sept. 14, 2017. Surf therapy is medically appointed and provides treatment for a host of maladies, including post-traumatic stress disorder and chronic pain. DoD photo by EJ Hersom

Today, adaptive surfing is more mainstream, with its third world championship taking place in December in La Jolla, California. Michalewicz-Kragh said when the clinic first started using surfing therapy, she only thought of the physical benefits, such as the cardio ability and strengthening the posterior muscles.

“We ended up realizing the benefit surfing has for post-traumatic stress disorder and other mental health issues,” she added. “It’s been an amazing journey.”

Finding Fitness, Friends

Surfing is like a medication, and all the side effects are good, Michalewicz-Kragh said. “A person may come here to surf but they end up finding a community,” she explained. “The side effects will be that his fitness level will be better, his cardiovascular ability improves, he gets stronger, and he meets a lot of people. The community integration aspect is really important, so there are many benefits to surfing.”

She said patients don’t need to know how to surf before showing up and they can attend the swim clinic beforehand. “Our goal for the patients as they come to the program is to find out how they can make their life better by surfing and to have the ability to surf and become a better surfer,” she said. “You will not be Kelly Slater after six weeks, and not after 12, but you will have the tools to know how to practice and learn how to surf on your own safely and independently.”

Also Read: Adaptive sports camp helps wounded warriors reach new heights

Beach Yoga

Before surfing, patients can also take yoga classes at the beach, thanks to Navy Cmdr. Lori Christensen, the Navy medical center’s preventive medicine department head.

“I always check with them at the beginning of class as they check in, where they’re hurting, so I can make sure they focus the class on things that will be beneficial to any particular needs they may have and then ask them afterward,” Christensen said. “I’ve had feedback from some patients who say that this is the only thing they’ve found that helps them feel better, and some who say, ‘I hated yoga, but now I love it,’ so that’s encouraging. It’s a great setting. It’s not me; it’s the beach.”

Christensen said programs such as the surfing clinic are important for wounded warriors. “It gives them hope and confidence, which will help them with their depression if they have it,” she said. “It’s giving them hope that they can get better, confidence in their abilities to do so, and then ability and new skills and new talents.”

Why a TBI is so dangerous — and how to treat it
Navy Cmdr. Lori Christensen, head of the Naval Medical Center San Diego’s preventive medicine department, instructs a yoga therapy session on the beach in Del Mar Calif., Sept. 14, 2017. DoD photo by EJ Hersom

Volunteers

The patients can go through the six-week program twice to learn surfing, and those who transition out of the military and stay in the local area can continue with the program. About 50 surfers — retired firefighters, police officers and military, along with the Del Mar lifeguards — volunteer to work with the patients in the surf therapy clinic.

Former Air Force Sgt. Warren James, a Vietnam veteran, has been volunteering for the past two years. “I’m really good at teaching the beginners,” the former avionics technician said. “It’s very rewarding for me, and I can see it’s very effective for the patients.”

James, who repaired radios and radar equipment on F-4, C-130 and C-40 aircraft during his military service, said he enjoys volunteering with service members and fellow veterans. “It’s overwhelming sometimes. They have injuries, and I didn’t really get injured, so I feel for them,” he said. “I saw a lot of bad things, and I don’t say much about it, but it’s really good to be able to talk to somebody else about it. I know how they feel … I didn’t have PTSD, but I can sense when they do, and it’s really comforting to help them and know that it’s helping me, too.”

Volunteers attend a briefing for the Naval Medical Center San Diego surf therapy session in Del Mar, Calif., Sept. 14, 2017. Surf therapy is medically appointed and provides treatment for a host of maladies, including post-traumatic stress disorder and chronic pain. DoD photo by EJ Hersom

Surfing clinic participants gain confidence as they make progress in the surfing clinic, he said. “If they had a physical injury, they recover quicker,” he added. “They take less medication. It’s just a really good program.”

Why a TBI is so dangerous — and how to treat it
Navy Cmdr. Lori Christensen, head of the Naval Medical Center San Diego’s preventive medicine department, instructs a yoga therapy session on the beach in Del Mar Calif., Sept. 14, 2017. DoD photo by EJ Hersom

Patients’ Opinions

Retired Marine Corps Sgt. Toran Gaal, a bilateral amputee who lives in Valley Center, California, said surfing brings him closer to those he lost in combat. He was injured in an improvised explosive device blast in Afghanistan in 2011.

“To be in a place like the ocean, it allows me to be closer to those people and feel like I’m lifted up,” Gaal said. “I feel like I’m around them when I’m out there. I feel like they’re around me, watching over me, making sure I’m safe. The ocean allows me to feel close to them, as well as gain relationships with some of the volunteers to be happy.”

The surfing clinic is about surfing and reintegration into the community, Gaal said. “It’s not just about gaining independence and going out and surfing. It’s about reintegration and transitioning,” he said.

Gaal said he and his wife, Lisa, have become friends and family with Bob Bishop, one of the volunteers, with whom they have regular lunches at Bishop’s home.

Navy Cmdr. Lori Christensen, head of the Naval Medical Center San Diego’s preventive medicine department, instructs a yoga therapy session on the beach in Del Mar Calif., Sept. 14, 2017. DoD photo by EJ Hersom

“It’s just a sense of family for me, and my wife knows that. She knows that when I’m around these people, I come back happier because I enjoy being in their presence and the negativity is not there. They’re all positive influences,” Gaal said.

Why a TBI is so dangerous — and how to treat it
Volunteer Brianna Phillip helps Navy Seaman Emily Wallace, left, walk into the surf to meet her instructo,r Necia Snow, right, during a surf therapy session for Naval Medical Center San Diego patients in Del Mar, Calif., Sept. 14, 2017. Wallace suffers from an illness that causes severe pain, and the medically appointed surf therapy helps to manage her pain. DoD photo by EJ Hersom

Marine Corps Cpl. Leighton Anderson, a Gardena, California, native who was injured during an MV-22 Osprey tilt-rotor aircraft crash in 2016, said he enjoys the surfing clinic as well.

“I always wanted to learn how to surf, since I’m from California,” Anderson said. “I tried it three times in my life and never did it. I was like, ‘Let me try it through here,’ and then after that, I was hooked. It was pretty sweet. I love it. Everybody’s really nice and supportive.”

Anderson said surfing helps him physically and mentally.

“I had so many barriers, because once I was injured, I was like, ‘I don’t know if I can do that. I might hurt myself.’ I have a little PTSD, and I didn’t think I would enjoy anything. Once I tried it, I broke down a lot of barriers I had mentally and physically. I had weak tendons in my hand and foot, but with surfing they’re starting to get better. And mentally, it makes me happy. It’s just something everybody should take on.”

“Surfing therapy is amazing,” James said. “The program works, because it keeps them not thinking what they would normally would be thinking when they’re at a medical appointment. But here, we just talk about other things, and that’s why it works.

“It’s different,” he added. “I definitely suggest getting in the water, even if you have no experience at all. Just come to the beach.”

Articles

‘Noose around the neck of ISIS’ as carrier airstrikes move south

ABOARD THE USS GEORGE H.W. BUSH, Persian Gulf — The hiss and scream of F/A-18 Super Hornets launching from the flight deck is business as usual on this city at sea, where sorties on Islamic State targets in Iraq and Syria have been launched a dozen or more times a day since early February.


When aircraft loaded with AIM-9 Sidewinder missiles and 1,000-pound bombs aren’t being catapulted into flight, training and qualification flights commence.

Constant through the action is a sort of deck ballet of positioning, as the 74 aircraft based on the ship are guided onto elevators for maintenance and storage, or moved to make room for the daily C-2 Greyhound delivery of people and Amazon packages.

The routine of life aboard the carrier is perhaps the most conventional element of the unconventional war against ISIS.

American troops on the ground in Iraq and Syria, mostly special operations and advisory elements, operate in relative secrecy, with few opportunities for journalists to observe them up close.

Why a TBI is so dangerous — and how to treat it
U.S. Navy photo by Mass Communication Specialist 3rd Class Matt Brown

On the carrier, by contrast, public affairs officers host three or four media visits per month, boarding them in comparatively luxurious “distinguished visitor” berthing, complete with monogrammed bathrobes, and offering them interviews with pilots and unit commanding officers.

Aboard the carrier, multiple sailors said they are on their second deployment in support of Operation Inherent Resolve — the coalition anti-ISIS fight — and compared the consistency of operations today favorably to the frenetic nature of the campaign when it first began in 2014.

With OIR about to enter its third year next month, the commander of the Bush carrier strike group said he is seeing progress in the fight.

Related: Iran tests advanced torpedo in Strait of Hormuz

While many strikes continue to target enemy positions in Raqqa, Syria, and Mosul, Iraq, where assaults on ISIS’s urban strongholds continue, the carrier’s fighter pilots are seeing more missions to the south, along the Euphrates River Valley. The strikes follow the path of retreating ISIS leaders, Rear Adm. Ken Whitesell said.

“Their vision of a geographic caliphate is coming to an end,” Whitesell told Military.com. “As they move and that unblinking eye stays on top of them, they will be targeted as they move down the valley.”

The number of fighter sorties launched from the carrier daily ranges from 12 to more than 20, plus several EA-18G Growler electronic warfare sorties, said Capt. Will Pennington, commanding officer of the Bush.

Pilots fly punishing eight-hour missions one to three times a week, in addition to daily training and currency flights. But the mission tempo has stayed largely steady since the carrier deployed, and the air wing has yet to be pushed to its limits, he said.

“We’re not surging to make this happen; this is a comfortable pace. We could up it and still get comfortable,” Pennington said.

The fight is proceeding carefully and deliberately from the air in large part because of the complexity of the urban ground battle. In Iraq, where a little more than half of the air wing’s sorties are tasked, the strike mission was simpler before coalition forces arrived in Mosul, he said.

“There were more targets and less complicated aerials,” Pennington said. “Now that the effort is moving forward and being successful … that operation, both from the ground and the air, needs to be carried out with much more prudence, given civilian entanglement.”

Why a TBI is so dangerous — and how to treat it
U.S. Navy photo by Mass Communication Specialist Seaman Neo Greene III

In both Mosul and Raqqa, the ground fights have been slow-moving. Coalition troops began their first assault on Mosul in October, and began a campaign to retake Raqqa the following month. Whitesell pointed optimistically to the words of Iraqi Army Chief of Staff Othman Al-Ghanmi, who predicted earlier this month that the fall of ISIS in Mosul would be complete in just three weeks.

It’s not the first time a top official has predicted victory close at hand. But the changing nature of strike targets also gives Whitesell reason to believe the end is near.

In addition to targets including enemy personnel, vehicles and improvised explosive devices, Whitesell said pilots are being tasked with destroying a key source of the militant group’s economic survival: oil wells.

While previously aircraft would target vehicles used to transport the oil, most of those are gone, thanks to the air mission, he said. “Now we get it before it comes out of the ground.”

Whitesell contrasts today’s operational picture to that of 2014, when the Bush became the first aircraft carrier to launch airstrikes on ISIS.

Why a TBI is so dangerous — and how to treat it
U.S. Navy photo by Mass Communication Specialist 3rd Class Christopher Gaines

“ISIS had made the push out of Syria and Raqqa, way down, so they had incredible geography. So this carrier was the first striking on the Iraqi assets to stop ISIS at the gates of Baghdad and start moving them back,” he said. “Fast-forward three years to where we are. We’ve got, essentially, a noose tied around the neck of ISIS.”

On a given day, a pilot might be tasked with engaging a specific target over Iraq or Syria, or with flying to a region and remaining “on call,” to be assigned a future target, sometimes with scant notice, by a controller on the ground.

Also read: Here’s how the F-16 Falcon could replace the F-15 Eagle

While pilots’ assignments can change at any time during the mission, they generally know the day’s mission set by the time they’re walking to their aircraft on the flight deck, said Lt. Cmdr. “Butters” Welles, a pilot with Strike Fighter Squadron 37, the “Ragin’ Bulls.” The squadron flies the F/A-18C Hornet.

Multiple pilots who spoke with Military.com asked that their full first and last names not be used, a subtle acknowledgment of online threats ISIS militants have made on various occasions against U.S. troops and their families.

Welles, who is on his fourth combat deployment, said he still feels the power of the moment when dropping ordnance on a ground target.

Why a TBI is so dangerous — and how to treat it
U.S. Navy Photo by Mass Communication Specialist 2nd Class Sean M. Castellano

It’s a sense similar to other high-stress moments, whether it’s landing on the ship at night or doing something that requires intense attention,” he said. “There’s a sense of time compression, where everything sort of slows down, but you feel like it’s still moving very quickly … it’s definitely a very intense moment.”

At that point, a pilot’s day is far from done. Still ahead are a series of tanker refueling operations, a flight back to the ship, and hours of debriefs. The workday of a pilot with a strike mission can easily stretch to 12 hours or more, the work continuing long after exiting the cockpit.

But after a day in the fight, they return to the ship, where four meals are served daily, gyms and movie channels are available for free time, and routine keeps chaos at bay.

And pilots are well aware of the contrast between the reality of the island-like carrier and that of coalition troops in the gritty, drawn-out ground battles.

“It’s a very different perspective and involvement for us to be up and somewhat detached from what’s going on down on the ground,” Welles said. “So I would say it’s a sense of pride, knowing that we contributed in some way to a very difficult effort on the ground. Because once we’re complete, and we either leave to airborne refuel, or need to go home, then the people we’re talking with are still there in the fight.”

Humor

6 easy ways for a grunt to be accepted by POGs

The greatest divide in the U.S. Military is between grunts and the POGs. For as long as this divide has existed, the higher-ups have been trying to find ways to close this gap. To you peacemakers, we say, “good luck.”


Today, we offer insight on how an infantryman can earn respect from their rear-echelon counterparts.

Related: 6 ways for a POG to be accepted by grunts

6. Don’t act like your job is more important

Even though every other job in the military exists to support the infantry, it’s a good idea to stay humble when interacting with a POG. After all, it’s a team effort.

Why a TBI is so dangerous — and how to treat it

5. Teach POGs how to wear their gear

If you see a POG wearing their gear all f*cked up, just pull them aside and give them a hip-pocket class on wearing it right. That is all.

Why a TBI is so dangerous — and how to treat it
Teach them what not to bring while you’re at it. (Image via DVIDS)

4. Help a POG learn infantry tactics

It might be a headache introducing grunt concepts to a POG, but teaching them how to properly clear a room helps build friendships and better teamwork.

This one might save your life one day — and this’ll give POGs something to show their friends back home.

Why a TBI is so dangerous — and how to treat it
Circle up and host a quick master class. (Image via U.S. Department of Defense)

3. Get a damn haircut

POGs generally always have access to haircuts. So, of course, they expect that every grunt ought to keep clean as well — even after spending several weeks in the field or in a place where the only barbers are in your platoon.

And most of the so-called “barbers” learned to cut hair from YouTube tutorial videos.

Why a TBI is so dangerous — and how to treat it
Long hair is acceptable if you’re a part of special operations. (Image via Army Times)

2. Don’t act like your experience gives you rank

This one undoubtedly grinds a POG’s gears. Even if you have numerous deployments under your belt, respect everyone’s rank and speak to them with tact.

Just because that brand-new second lieutenant is fresh out of college and has no military experience doesn’t make them less of a Marine. Always say sh*t like, “with all due respect, sir,” before jumping directly into, “kiss my lower-enlisted ass, sir.”

That way, everyone wins!

Why a TBI is so dangerous — and how to treat it
Even if that POG has been spending their whole career behind a desk, swallow your pride and show respect. (Image via DVIDS)

Also read: 5 reasons you should know about the hardcore Selous Scouts

1. Stop being so cool

Let’s face it, they don’t put the 0161 postal clerk on the posters in the Marine Corps recruiting office. No — they put the 0311 Infantry Riflemen and/or the 0351 Infantry Assaultmen on those posters!

Everyone knows these jobs are cool, just make sure you show some respect to everyone, including mailmen MOS.

Why a TBI is so dangerous — and how to treat it
So cool. (Image via SOFREP)

*Bonus* Have some manners.

Make sure you thank the cook bringing you hot chow or the motor vehicle operator for the ride back to the rear. After all, without them, it’s cold MREs and long hikes.

Why a TBI is so dangerous — and how to treat it
You know you would have preferred a ride home instead of walking through this crap. (Image from USMC)

MIGHTY TRENDING

Rebels recover vehicle of US Special Forces ambushed in Niger

A Tuareg rebel leader said March 13, 2018, that members of his group have recovered an American vehicle that was stolen in the ambush in Niger in which four U.S. forces were killed in October 2017.


The vehicle taken during the attack in Tongo Tongo, Niger was found on the Malian side of the border in the desert, said Fahad Ag Al Mahmoud, secretary-general of the rebel group known by its French acronym, GATIA.

Read more: This timeline shows how the Niger operation went down

“Our men are in the middle of digging out the vehicle to get it back in working order,” he said.

He said it was not immediately possible to send a photo to confirm they had retrieved the vehicle, because of the lack of internet in the remote border area.

Why a TBI is so dangerous — and how to treat it
Nigerien army soldiers shoot targets under 60mm illumination mortar rounds.

A coalition of armed Tuareg rebels has been operating against jihadist groups active in the area between Mali and Niger for several weeks.

Four U.S. forces and four Nigerien troops were killed Oct. 4, 2017, about 120 miles (200 kilometers) north of Niamey, Niger’s capital, when they were attacked by as many as 100 Islamic State-linked extremists traveling by vehicle and carrying small arms and rocket-propelled grenade launchers. Two other American soldiers and eight Nigerien forces were wounded.

More: This is the general demanding answers for the families of the soldiers who died in Niger

A U.S. military investigation into the Niger attack concluded that the team didn’t get required senior command approval for a risky mission to capture a high-level Islamic State militant, though it did not point to that failure as a cause of the deadly ambush, several U.S. officials familiar with the report said.

The investigation found no single point of failure leading to the attack. It also drew no conclusion about whether villagers in Tongo Tongo, where the team stopped for water and supplies, alerted extremists to American forces in the area.

MIGHTY TACTICAL

Army will get first light tank prototypes in 2020

The U.S. Army awarded contracts Dec. 17, 2018, to two defense firms to build prototypes of a new lightweight tank to give infantry units the firepower to destroy hardened enemy targets.

The service awarded General Dynamics Land Systems Inc. and BAE Systems Land & Armaments LP with what’s known as Middle Tier Acquisition (Section 804) contracts worth up to $376 million each to produce prototypes of the Mobile Protected Firepower (MPF) system.


The two companies will build 12 prototypes each and begin delivering them to the Army in about 14 months so testing can begin in spring 2020. The goal is to down-select to a winner by fiscal 2022 and begin fielding the first of 504 of these lightweight tanks sometime in fiscal 2025.

“This capability is much needed in our infantry forces,” Brig. Gen. Ross Coffman, director of the Next Generation Combat Vehicle Cross Functional Team, told reporters at the Pentagon on Dec. 17, 2018.

Why a TBI is so dangerous — and how to treat it

MGM-51 Shillelagh Anti-tank missile fired from M551 Sheridan light tank.

“As we close with the enemy, at this time, there is artillery — which is area fires that can be used — but there is no precision munition to remove bunkers from the battlefield and to shoot into buildings in dense urban terrain to allow infantryman to close with the enemy,” he said.

The MPF concept emerged several years ago when maneuver leaders started calling for a lightweight, armored platform armed with a large enough cannon to destroy hardened targets for light infantry forces. The idea was to field it to airborne units for forced-entry operations.

Parachute infantry battalions can be used to seize airfields as an entry point for heavier follow-on forces. Airborne forces, however, lack the staying power of Stryker and mechanized infantry.

The 82nd Airborne Division was equipped with the M551 Sheridan Armored Reconnaissance Airborne Assault Vehicle until the mid-1990s. Developed during the Vietnam War, the Sheridan resembled a light tank and featured a 152mm main gun capable of firing standard ammunition or the MGM-51 Shillelagh anti-tank missile.

The MPF, however, will not be air-droppable, Coffman said, explaining that Air Force C-17 Globemasters will carry two MPFs each and air-land them after an airfield has been secured.

Why a TBI is so dangerous — and how to treat it

A U.S. Air Force C-17 Globemaster III T-1 flies over Owens Valley, California, for a test sortie.

(US Air Force photo)

Army requirements call for the MPF to be armed with a 105mm or possibly a 120mm cannon and rely on tracks to maneuver over terrain so it can keep up with advancing infantry, Coffman said.

GDLS and BAE beat out SAIC and its partner ST Kinetics, but Army officials would not comment on the reason the winners were chosen.

“This is an integration of mature technology. The vehicles don’t exist, but the technologies — the pieces, the systems, the subsystems — they do exist,” said David Dopp, project manager for MPF.

The plan is to conduct developmental testing to assess the prototypes’ mobility, survivability, and lethality.

“So these have a long-range precision weapon system on them, so over … several kilometers, how well do they perform? How lethal are they?” Coffman said. “They are going to take a couple of these vehicles out, and they are going to shoot them with likely enemy caliber munitions. They are going to see which ones can absolutely protect our soldiers.”

The Army then will move into a soldier vehicle assessment followed by a limited user test scheduled for fiscal 2021, Dopp said.

“In the soldier user test, we will execute likely missions that [infantry brigade combat team] will have in full-scale combat,” Coffman said. “So this isn’t driving down the road looking for IEDs; this is American soldiers engaged in full-scale combat.”

This article originally appeared on Military.com. Follow @militarydotcom on Twitter.

MIGHTY CULTURE

This is the Pentagon’s missile defense strategy

James H. Anderson, the assistant secretary of defense for strategy, plans, and capabilities, spoke about the 2019 Missile Defense Review at the Brookings Institution in Washington, Jan. 29, 2019. He noted that the strategy covers the Defense Department’s three lines of effort: lethality, partnership and reform.

Here are his main points:


The threat

China and Russia are developing advanced cruise missiles and hypersonic weapons that can potentially overcome United States defenses. North Korea has tested intercontinental ballistic missiles that are capable of reaching the U.S. and could be armed with nuclear warheads. And, Iran’s space program could accelerate development of an ICBM system that might be able to reach the U.S.

Why a TBI is so dangerous — and how to treat it

2019 missile defense review goal

Diplomacy and deterrence are the primary strategies to protect the nation, deployed forces and U.S. allies from missile attacks. Should that fail, the U.S. is developing a layered missile defense system as well as offensive capability.

Why a TBI is so dangerous — and how to treat it

The ballistic missile submarine USS Tennessee gold crew returns to its home port at Naval Submarine Base Kings Bay, Ga., Jan. 11, 2019, following a strategic deterrence patrol.

(Photo by Bryan Tomforde)

Lethality strategy

• Upgrade existing radars and sensors

• Increase the number of ground-based interceptors by 20 to 64, along with developing a new kill vehicle for the GBI

• Develop small, high-energy lasers that can be fitted on unmanned aerial systems

• Arm F-35 Lightning II aircraft with tracking capabilities and possible missile intercept at the early boost stage

• Increase the Navy’s fleet of Aegis-equipped destroyers from 38 to 60

• Improve space-based sensors to detect and track missiles

• Conduct a feasibility study of space-based missile intercept capability

• Conduct a Standard Missile-3 Block IIA test against ICBMs by 2020

• Leverage the SM-6 for both defensive and strike operations.

Why a TBI is so dangerous — and how to treat it

A Standard Missile 3 Block IIA launches from the Aegis Ashore Missile Defense Test Complex at the Pacific Missile Range Facility in Kauai, Hawaii, Dec. 10, 2018, during a test to intercept an intermediate-range ballistic missile target in space.

(Photo by Ryan Keith)

Partnership strategy

To address regional threats and protect partners, Anderson said the U.S. will deploy additional terminal high altitude area defense, Patriot and Aegis Ashore platforms.

In turn, partner nations are building up their air and missile defenses, with the possibility of integrating them with U.S. systems. For example, he noted that NATO has an operational Aegis Ashore site in Romania. A second site, to be operational in about a year, is being built in Poland, which will house SM-3 Block IIA missiles. Denmark and the Netherlands have sea-based radar systems that can locate missiles.

Reform strategy

DOD must adopt processes and cultures that enable development and procurement of missile defense systems in a streamlined and cost-effective manner, Anderson said.

“We must not fear test failure, but learn from it and rapidly adjust,” he said.

Articles

Buzz kill: States might have legalized pot, but the feds still haven’t

Why a TBI is so dangerous — and how to treat it
Marijuana, along with nine other substances, is specifically prohibited under Article 112a of the Uniform Code of Military Justice and penalties for its use can range from a general discharge to dishonorable discharge (for positive results of a urinalysis) and even imprisonment for possession.


During election week, four states legalized medicinal marijuana use, joining a list of 40 states and the District of Columbia in saying “Mary Jane is a friend of mine — in some form or another.”

The federal government, however, is saying “not if you value your 2nd amendment rights.”

Currently, marijuana is legal for recreational use in Alaska, California, Colorado, Massachusetts, Nevada, Oregon, Washington, and Washington D.C.

Arkansas, Florida, Montana and North Dakota all voted last week to allow medical marijuana use, joining 17 other states who acknowledge the medicinal value of cannabis.

Outside of those 29 states, limited medical marijuana use (which generally refers to cannabis extracts) is legal in 15 other states.

The states that don’t allow any type of marijuana use are Idaho, South Dakota, Nebraska, Kansas, Indiana, and West Virginia.

While the Veterans Administration admits that it hasn’t conducted any studies to determine if medical marijuana can successfully treat PTSD, they do admit that there seems to be anecdotal evidence to support that claim.

Use of “oral CBD [cannabidiol] has been shown to decrease anxiety in those with and without clinical anxiety” the VA notes.

The VA goes on to explain that an ongoing trial of THC, one of the compounds in cannabis, shows the compound to be “safe and well tolerated” among participants with PTSD, and that it results in “decreased hyperarousal symptoms.”

According to an investigation by PBS’s “Frontline,” marijuana’s “danger” label came about predominantly as a result of a smear campaign against immigrants between 1900 and the 1930s.

The network acknowledges a report from the New York Academy of Medicine that states that, despite popular opinion, marijuana does not “induce violence, insanity or sex crimes, or lead to addiction or other drug use.” That report has not been refuted by scientific research to date.

In 1972, President Nixon ordered the Shafer Commission to look at decriminalizing marijuana use, and the commission determined that the personal use of it should, in fact be decriminalized.

President Nixon, according to PBS, rejected that recommendation.

To this day, marijuana use and possession is a federal crime, despite being overwhelmingly accepted by nearly all of the country in some form or another.

So why does this matter to the military and veteran community?

It all comes down to federal law. While a majority of the country recognizes the benefits and harmlessness of cannabis, the federal government does not.

In fact, the feds say marijuana users immediately forfeit their Second Amendment rights by consuming cannabis.

On September 7th the Washington Post reported that the U.S. Circuit Court of Appeals for the 9th Circuit ruled that federal law “prohibits gun purchases by an ‘unlawful user and/or addict of any controlled substance.’ ”

The court claims that marijuana users “experience altered or impaired mental states that affect their judgement” and that this impaired judgement leads to “irrational” behavior, despite the findings by both the New York Academy of Medicine and the Shafer Commission to the contrary.

Background checks for firearms purchases require buyers to acknowledge whether they are a “habitual user” of marijuana and other illegal drugs. If they truthfully answer “yes,” they are barred from buying a gun. That means gun buyers in states that legalized marijuana use had better not indulge in the new right.

Will this change any time soon?

To answer that question, one needs to look at how legalization has impacted the finances in the states that have made pot kosher. After-all, money makes the world go ’round.

According to CheatSheet, Oregon banked $3.5 million in its first month of recreational marijuana sales. Washington State hit the jackpot with $70 million its first year, and Colorado rolled a fat one with $135 million in 2015 alone.

That was enough for the U.S. Congress to pause and say “let’s think about this.” Currently sitting in the Senate right now is S.683 , or the Compassionate Access, Research Expansion, and Respect States Act (CARES).

Introduced by Democrat New Jersey Sen. Cory Booker in March 2015, the act moves to transfer marijuana from a schedule I to a schedule II drug, protect marijuana dispensaries from being penalized for selling marijuana, and directs the VA to authorize medical providers to “provide veterans with recommendations and opinions regarding participation in state marijuana programs”, among other things.

To give an idea of what a schedule II drug is, the U.S. Department of Justice lists ADHD medication as a schedule II drug.

So when will marijuana use be decriminalized on a federal level? It’s too soon to tell.

Until then, veterans will have to choose between our pot and our guns.

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