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Focus on trauma: Civilian, military training opens eyes to brain injuries

  • Guardsmen sit in the field while waiting for a black hawk helicopter to land before taking a ride at the Millitary Orientation Program for Brain Injury Professionals at the New Hampshire National Guard's Central Training Site in Strafford on Thursday, May 8, 2014. <br/><br/>(ANDREA MORALES / Monitor staff)

    Guardsmen sit in the field while waiting for a black hawk helicopter to land before taking a ride at the Millitary Orientation Program for Brain Injury Professionals at the New Hampshire National Guard's Central Training Site in Strafford on Thursday, May 8, 2014.

    (ANDREA MORALES / Monitor staff) Purchase photo reprints at PhotoExtra »

  • Kathy Chase, an emergency room nurse at Portsmouth Regional Hospital, lays on a stretcher during a MEDEVAC demonstration at the Millitary Orientation Program for Brain Injury Professionals at the New Hampshire National Guard's Central Training Site in Strafford on Thursday, May 8, 2014. <br/><br/>(ANDREA MORALES / Monitor staff)

    Kathy Chase, an emergency room nurse at Portsmouth Regional Hospital, lays on a stretcher during a MEDEVAC demonstration at the Millitary Orientation Program for Brain Injury Professionals at the New Hampshire National Guard's Central Training Site in Strafford on Thursday, May 8, 2014.

    (ANDREA MORALES / Monitor staff) Purchase photo reprints at PhotoExtra »

  • Kathy Blinn, an emergency room nurse at the Southern New Hampshire Medical Center in Nashua, laughs while in the rollover simulation machine at the Millitary Orientation Program for Brain Injury Professionals at the New Hampshire National Guard's Central Training Site in Strafford on Thursday, May 8, 2014. <br/><br/>(ANDREA MORALES / Monitor staff)

    Kathy Blinn, an emergency room nurse at the Southern New Hampshire Medical Center in Nashua, laughs while in the rollover simulation machine at the Millitary Orientation Program for Brain Injury Professionals at the New Hampshire National Guard's Central Training Site in Strafford on Thursday, May 8, 2014.

    (ANDREA MORALES / Monitor staff) Purchase photo reprints at PhotoExtra »

  • Sgt. William Roth (right) sits on a empty Meal, Ready-to-eat box while eating one of the army's signature prepared meals while on lunch break at the Millitary Orientation Program for Brain Injury Professionals at the New Hampshire National Guard's Central Training Site in Strafford on Thursday, May 8, 2014. All participants ate one for lunch also.<br/><br/>(ANDREA MORALES / Monitor staff)

    Sgt. William Roth (right) sits on a empty Meal, Ready-to-eat box while eating one of the army's signature prepared meals while on lunch break at the Millitary Orientation Program for Brain Injury Professionals at the New Hampshire National Guard's Central Training Site in Strafford on Thursday, May 8, 2014. All participants ate one for lunch also.

    (ANDREA MORALES / Monitor staff) Purchase photo reprints at PhotoExtra »

  • Sgt. Dustin Glidden (center) explains the power of the 40mm fully automatic grenade launcher at the Millitary Orientation Program for Brain Injury Professionals at the New Hampshire National Guard's Central Training Site in Strafford on Thursday, May 8, 2014. <br/><br/>(ANDREA MORALES / Monitor staff)

    Sgt. Dustin Glidden (center) explains the power of the 40mm fully automatic grenade launcher at the Millitary Orientation Program for Brain Injury Professionals at the New Hampshire National Guard's Central Training Site in Strafford on Thursday, May 8, 2014.

    (ANDREA MORALES / Monitor staff) Purchase photo reprints at PhotoExtra »

  • Sgt. John Cilley wraps Lorene Zammuto's head during a patrol injury simulation at the Millitary Orientation Program for Brain Injury Professionals at the New Hampshire National Guard's Central Training Site in Strafford on Thursday, May 8, 2014. <br/><br/>(ANDREA MORALES / Monitor staff)

    Sgt. John Cilley wraps Lorene Zammuto's head during a patrol injury simulation at the Millitary Orientation Program for Brain Injury Professionals at the New Hampshire National Guard's Central Training Site in Strafford on Thursday, May 8, 2014.

    (ANDREA MORALES / Monitor staff) Purchase photo reprints at PhotoExtra »

  • Lorene Zammuto, the director of nursing at Lakeview Neurorehabilitation in Effingham, peeks out from under a wrap placed on her during a patrol injury demonstration at the Millitary Orientation Program for Brain Injury Professionals at the New Hampshire National Guard's Central Training Site in Strafford on Thursday, May 8, 2014. <br/><br/>(ANDREA MORALES / Monitor staff)

    Lorene Zammuto, the director of nursing at Lakeview Neurorehabilitation in Effingham, peeks out from under a wrap placed on her during a patrol injury demonstration at the Millitary Orientation Program for Brain Injury Professionals at the New Hampshire National Guard's Central Training Site in Strafford on Thursday, May 8, 2014.

    (ANDREA MORALES / Monitor staff) Purchase photo reprints at PhotoExtra »

  • Sgt. Corey Caza holds a target practice gun at the Millitary Orientation Program for Brain Injury Professionals at the New Hampshire National Guard's Central Training Site in Strafford on Thursday, May 8, 2014. <br/><br/>(ANDREA MORALES / Monitor staff)

    Sgt. Corey Caza holds a target practice gun at the Millitary Orientation Program for Brain Injury Professionals at the New Hampshire National Guard's Central Training Site in Strafford on Thursday, May 8, 2014.

    (ANDREA MORALES / Monitor staff) Purchase photo reprints at PhotoExtra »

  • Sgt. Michael Fletcher chats about the black hawk helicopter while at the Millitary Orientation Program for Brain Injury Professionals at the New Hampshire National Guard's Central Training Site in Strafford on Thursday, May 8, 2014. <br/><br/>(ANDREA MORALES / Monitor staff)

    Sgt. Michael Fletcher chats about the black hawk helicopter while at the Millitary Orientation Program for Brain Injury Professionals at the New Hampshire National Guard's Central Training Site in Strafford on Thursday, May 8, 2014.

    (ANDREA MORALES / Monitor staff) Purchase photo reprints at PhotoExtra »

  • Guardsmen sit in the field while waiting for a black hawk helicopter to land before taking a ride at the Millitary Orientation Program for Brain Injury Professionals at the New Hampshire National Guard's Central Training Site in Strafford on Thursday, May 8, 2014. <br/><br/>(ANDREA MORALES / Monitor staff)
  • Kathy Chase, an emergency room nurse at Portsmouth Regional Hospital, lays on a stretcher during a MEDEVAC demonstration at the Millitary Orientation Program for Brain Injury Professionals at the New Hampshire National Guard's Central Training Site in Strafford on Thursday, May 8, 2014. <br/><br/>(ANDREA MORALES / Monitor staff)
  • Kathy Blinn, an emergency room nurse at the Southern New Hampshire Medical Center in Nashua, laughs while in the rollover simulation machine at the Millitary Orientation Program for Brain Injury Professionals at the New Hampshire National Guard's Central Training Site in Strafford on Thursday, May 8, 2014. <br/><br/>(ANDREA MORALES / Monitor staff)
  • Sgt. William Roth (right) sits on a empty Meal, Ready-to-eat box while eating one of the army's signature prepared meals while on lunch break at the Millitary Orientation Program for Brain Injury Professionals at the New Hampshire National Guard's Central Training Site in Strafford on Thursday, May 8, 2014. All participants ate one for lunch also.<br/><br/>(ANDREA MORALES / Monitor staff)
  • Sgt. Dustin Glidden (center) explains the power of the 40mm fully automatic grenade launcher at the Millitary Orientation Program for Brain Injury Professionals at the New Hampshire National Guard's Central Training Site in Strafford on Thursday, May 8, 2014. <br/><br/>(ANDREA MORALES / Monitor staff)
  • Sgt. John Cilley wraps Lorene Zammuto's head during a patrol injury simulation at the Millitary Orientation Program for Brain Injury Professionals at the New Hampshire National Guard's Central Training Site in Strafford on Thursday, May 8, 2014. <br/><br/>(ANDREA MORALES / Monitor staff)
  • Lorene Zammuto, the director of nursing at Lakeview Neurorehabilitation in Effingham, peeks out from under a wrap placed on her during a patrol injury demonstration at the Millitary Orientation Program for Brain Injury Professionals at the New Hampshire National Guard's Central Training Site in Strafford on Thursday, May 8, 2014. <br/><br/>(ANDREA MORALES / Monitor staff)
  • Sgt. Corey Caza holds a target practice gun at the Millitary Orientation Program for Brain Injury Professionals at the New Hampshire National Guard's Central Training Site in Strafford on Thursday, May 8, 2014. <br/><br/>(ANDREA MORALES / Monitor staff)
  • Sgt. Michael Fletcher chats about the black hawk helicopter while at the Millitary Orientation Program for Brain Injury Professionals at the New Hampshire National Guard's Central Training Site in Strafford on Thursday, May 8, 2014. <br/><br/>(ANDREA MORALES / Monitor staff)

As the humvee rolled onto its side, gravity pulled all my weight against the seat belt. My helmet slipped forward over my nose, and the world went dark.

I held my breath and unlatched the seat belt. Convincing yourself to undo the only thing holding you in your seat takes some mind-over-instinct determination.

With a thud, my knees collapsed into my stomach and my shins landed on the ceiling.

But with my helmet still over my face, I grasped blindly for the door latch. Thank goodness for the nurse who was sitting in the back seat. She reached out, grabbed my hand, and pulled me out the back door, into the harsh fluorescent lights of the simulator room.

Those few moments of breathless panic were the most real moments of pretend during the Military Orientation Training for Brain Injury Professionals, a biennial event developed by the Civilian/Military Traumatic Brain Injury Collaborative and the New Hampshire National Guard.

Ten percent of New Hampshire’s population has served in the armed forces, and fewer than half of them receive their medical care from the Veterans Administration.

Since brain injuries and PTSD can be invisible wounds, “don’t assume anything,” said Col. Roy Hunter.

“Don’t assume if they haven’t been to Iraq or Afghanistan that they don’t have PTSD. And don’t assume it’s only the grunts on the ground that have seen things,” he said.

The training, offered last Thursday and Friday at the National Guard facility in Center Strafford, gave civilian medical professionals and a few members of the news media a glimpse into military culture and a look at how brain injuries have come to be the most prevalent wound in the war on terror.

We lugged about 20 pounds of protective gear. We rode in a cramped Humvee with hardly any line of sight and in a chest-thumpingly loud Black Hawk helicopter with open-air windows. We ate mushy, lukewarm and overly salty rations. We shot air rifles and wiggled out of the Humvee roll-over simulator.

But most importantly, we talked to men and women who have been affected by brain injury and post-traumatic stress..

Jon Worrall of Brentwood, a retired Navy veteran who re-enlisted, celebrated his 50th birthday in Iraq.

And then, on Nov. 15, 2004, while out patrolling some “pretty bad roads,” he was rocked by an explosion about 2 meters away.

“You can’t describe the violence we saw,” he said.

He underwent 12 surgeries and has metal parts from his hands to his feet. He walks with a cane, and he almost lost his marriage to the unpredictable mood swings sparked by his brain injuries.

“Getting hit with a roadside bomb, there’s no retribution. I can’t hit somebody back. I can’t return fire,” Worrall said. “When you’re hit with a bomb, there’s not a frickin’ thing you can do about it.”

Now, he carries a small card in his wallet, in case he gets into a situation where his flight-or-flight instinct kicks in, he said.

It reads: “I am not mentally ill. I am a soldier who suffered a traumatic brain injury.”

But 10 years ago, traumatic brain injuries weren’t yet treated as “the signature injury of the war on terror.”

In 2004, the military followed the “get back on the horse” mentality, said Lt. Col. Richard Oberman of Penacook, deputy state surgeon for the New Hampshire National Guard. When a team experienced an explosion, their commanders thought the best way through it was full speed ahead.

By 2008, when the suicide death rate in the army first exceeded the civilian rate, the military began providing counselors to teams that had lost members in conflict or explosions, Oberman said.

And now, every commander is supposed to evaluate his troops during demobilization and refer anyone he or she thinks is at risk to a counseling program or medical evaluation. About 2 percent of all troops are referred to behavioral health evaluations during demobilization, he said.

Still, there’s a fear of seeing a counselor, of appearing weak or broken.

“I can’t force a soldier to participate in counseling. But every chance we get, we’re telling soldiers to get help. We tell them, asking for help does not disqualify you from service. Getting it too late does. We’re not here to kick people out of the army. We’re here to get people better,” he said.

Soldiers can often try to shrug off treatment, even when the force of the explosion is so strong, “you feel it rattle your chest,” said Sgt. William Roth of Hudson.

“It’s probably not the brightest idea, but we don’t always say anything,” he said. “It’s like football. You don’t want to miss the next game, or the next mission, and a lot of guys feel like, if they’re messed up, they’ll say something, but they don’t want to admit they’re messed up.”

Soldiers in a unit rely on their comrades to tell them when they need help, he said.

“It becomes like a buddy thing. You need a kick in the butt to move forward,” he said.

Worrall says one of the most healing things he’s done is help other returning veterans. He turned his retirement camp in Pittsburgh into a retreat for soldiers with brain injuries and post-traumatic stress. He tells them to get help, to see counselors. When they say they don’t need it, he asks if they think they’re tougher, more manly, than he is.

“I’m not less of a man because I have traumatic brain injury and PTSD. You gotta accept it. It sucks. But it happens. . . . What are you going to do — whine? I could do without that last bomb. But if it hadn’t happened, how could I tell these young guys I know where they are?” he said.

Worrall fidgeted with his cane top as his doctor and his commander, Col. Hunter, spoke about watching his journey from a man full of anger and unpredictable emotions to one with direction, in the process of healing.

“Working with Jon,” Oberman said, “taught me, ‘Don’t listen to him.’ The pride that’s there will make them turn away attention. When you’re there with soldiers and they’re telling you they’re fine, don’t listen.”

There’s only so much Chief Warrant Officer Michael Fletcher of Derry and his medevac team can do for an injured soldier.

They can stabilize someone; they can set up IVs, even in a windy, wobbling Black Hawk helicopter.

But there’s not much they can do once injured soldiers are released to the civilian world.

“A lot of the time, there’s a lack of treatment, and that comes from a lack of understanding,” Fletcher said.

“Today is like an extension of the care we try to provide in the helicopter. I want to make sure the people taking over for us understand what they did and what our job was, so they can give them the best care possible.”

Once the civilian medical system takes over, it can be hard to get soldiers to talk about their experience. Kathy Blinn, an emergency room nurse at Southern New Hampshire Medical Center in Nashua, said that in the past few months, her department has treated several young men who showed signs of mental illness or psychosis. It was only later, when family members got to the hospital, that the medical team learned the patients served in the military and may be suffering from a brain injury.

The training day “has given me a whole new appreciation for what they go through,” Blinn said. “I’m just wow’ed.”

(Sarah Palermo can be reached at 369-3322 or spalermo@cmonitor.com or on Twitter @SPalermoNews.)

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