Bob Woodruff: A Look at the Injuries

Bob Woodruff, co-anchor of ABC World New Tonight broadcast was seriously injured Sunday with his cameraman Doug Vogt from a roadside Improvised Explosive Device (IED). According to reports, Woodruff suffered wounds to his extremities as well as his head. He is currently recovering in Germany and is scheduled to be transferred tonight to a medical center in Bethesda, MD.

The most common cause of personnel wounded in action recently are due to roadside bombs. These are land mines or booby traps made out of locally available materials or another piece of ordnance, such as a cannon shell. These were used as far back as the Vietnam War. The IED today are larger as they are intended to damage the armored vehicle as well as the personnel inside of it.

I thought it would be interesting to review some of the injuries caused by these types of devices and some of the challenges facing Bob Woodruff in the coming months.

Most of the injuries caused by IED are traumatic in nature and are caused by foreign bodies. While woodruff suffered trauma to his extremities he was said to also have suffered head injuries. In the Iraq and Afghanistan conflicts, traumatic brain injury (TBI) accounts for 22 percent or higher of the injuries - a larger proportion of casualties than it has in other recent U.S. wars. This is because the personnel in Iraq and Afghanistan are wearing body armor which does a great job of protecting the core, however, their head and extremities are still exposed.

From an article published in the NEJM in May (Available here for free):

According to the Joint Theater Trauma Registry, compiled by the U.S. Army Institute of Surgical Research, 22 percent of the wounded soldiers from these conflicts who have passed through the military's Landstuhl Regional Medical Center in Germany had injuries to the head, face, or neck. This percentage can serve as a rough estimate of the fraction who have TBI, according to Deborah L. Warden, a neurologist and psychiatrist at Walter Reed Army Medical Center who is the national director of the Defense and Veterans Brain Injury Center (DVBIC). Warden said the true proportion is probably higher, since some cases of closed brain injury are not diagnosed promptly.

But those serving and touring do wear protective helmets and eye shields so how do they still have such a large proportion of Traumatic Brain Injury? There are also closed brain injuries:

Kevlar body armor and helmets are one reason for the high proportion of TBIs among soldiers wounded in the current conflicts. By effectively shielding the wearer from bullets and shrapnel, the protective gear has improved overall survival rates, and Kevlar helmets have reduced the frequency of penetrating head injuries. However, the helmets cannot completely protect the face, head, and neck, nor do they prevent the kind of closed brain injuries often produced by blasts. As insurgents continue to attack U.S. troops in Iraq, most brain injuries are being caused by IEDs, and closed brain injuries outnumber penetrating ones among patients seen at Walter Reed, where more than 450 patients with TBI were treated between January 2003 and February 2005.

A blast creates a sudden increase in air pressure by heating and accelerating air molecules and, immediately thereafter, a sudden decrease in pressure that produces intense wind. These rapid pressure shifts can injure the brain directly, producing concussion or contusion. Air emboli can also form in blood vessels and travel to the brain, causing cerebral infarcts. In addition, blast waves and wind can propel fragments, bodies, or even vehicles with considerable force, causing head injuries by any of these mechanisms. Approximately 8 to 25 percent of persons with blast-related injuries die.

Twenty five percent of those with blast related injuries die. Not such great odds for Woodward but so far all the indication are that he is improving.

Thus far, not much has been said to specifically address the injuries suffered by Woodruff. It is not known if they were serious enough to cause other complications.

The brain's size frequently increases after a severe head injury. This is called brain swelling and occurs when there is an increase in the amount of blood to the brain. Later in the illness water may collect in the brain which is called Brain Edema. Both Brain swelling and Brain Edema result in excessive pressure in the brain called Intracranial Pressure ("ICP"). Around-the-clock monitoring during this time is essential in order that Intracranial Pressure can be immediately treated. Treatment of brain swelling can be difficult. Very strong medications are administered and in some cases, removal of small amounts of fluids from the brain may be beneficial. If all these measures fail, a craniotomy may be performed.

But let’s say all ends well. What will Woodward have to face after his stay in the Intensive Care Unit?

Soldiers with TBI often have symptoms and findings affecting several areas of brain function. Headaches, sleep disturbances, and sensitivity to light and noise are common symptoms. Cognitive changes, diagnosed on mental-status examination or through neuropsychological testing, may include disturbances in attention, memory, or language, as well as delayed reaction time during problem solving. Often, the most troubling symptoms are behavioral ones: mood changes, depression, anxiety, impulsiveness, emotional outbursts, or inappropriate laughter.

Long term the prognosis is good. Most adults with a mild TBI recover completely within a year, but moderate and severe traumatic brain injuries are more likely to cause long term effects.

I am constantly amazed at the courage and perseverance of our young men and women who are in Iraq. Their life is threatened every single day. They are targets, just as those traveling with them are targets. Reporters who enter battlefields and war zones do it for the sake of their career and because it’s their job.

The endless numbers of those reporters who have been injured or captured as hostages continues to increase.

Is it really worth it?

So why do correspondents do it? Go here for the answer.