Physicians currently do not have many distinctions between explosive blast traumatic brain injury (bTBI), closed head traumatic brain injury (cTBI) and penetrative traumatic brain injury (pTBI), according to doctors. The military also uses the same criteria to assess such injuries as civilians.
A 1993 definition from the Mild Traumatic Brain Injury Committee of the American Congress of Rehabilitation Medicine of TBI apples to bTBI when an explosive blast causes loss of consciousness, amnesia, or loss of focus. The severity is determined by how long the altered mental state lasts. Less than 5 minutes is mild, though it can lead into difficulties like headaches, confusion, and amnesia, as well as a difficulty to concentrate, altered mood, problems sleeping, and general anxiety. These symptoms usually go within a few hours or days.
Studies in Manhattan and Long island have discovered that even these mild cases could result in post-concussive syndrome which could happen days later. Government agencies are currently developing guidelines to manage this condition, which seems to respond to simple reassurance and specific treatments like non-narcotic analgesics, anti-migraine medication to treat headaches, and anti-depressants. Just as with civilian cTBI, the problem might last only a few weeks, but it might well last a year or more in some cases.
Moderate bTBI is judged on the same criteria as comas, characterized by longer losses of consciousness and loss of neurological function. These cases might well require surgery, doctors have learned. Severe bTBI is significant brain injury that requires immediate care on the battlefield. Once the patient is stabilized, immediate transportation to a medical facility is necessary.