Law enforcement and correctional officers are at an elevated risk for head injury or fatal head trauma. High risk situations include traffic collisions, physical assaults by suspects and gunshot wounds. Although a brain makes up only 2% of an individual’s body weight, it is responsible for the thought process, voluntary and involuntary movements and other vital body functions. Injury to the brain can be fatal or cause permanent disability. A traumatic brain injury (TBI) is defined as a blow or jolt to the head, or a penetrating head injury, that disrupts the function of the brain. A TBI is caused by a physical force impacting the brain that produces a diminished or altered state of consciousness. The force to the head causes the brain to move within the skull, or causes the skull to break, directly harming the brain. Bruising, tearing and swelling of brain tissue can occur from the rotation of the brain against the skull. Head injuries are classified as either closed or penetrating. In a closed head injury, the head sustains a blunt force by striking against an object; an open head injury is caused by a penetrating object that leaves visible bleeding and exposed brain tissue.
Brain Injury Facts
According to the Centers for Disease Control and Prevention, almost 5.3 million Americans are living with disabilities associated with traumatic brain injuries. A brain injury occurs in this country every 16 seconds; a death from brain injury occurs every 12 minutes. Approximately two million head injuries occur each year in the United States. Between 75,000 and 100,000 Americans die each year as a result of those injuries. For those who survive, at least half a million individuals will require hospitalization and 70,000-90,000 will suffer long-term, physical, intellectual, psychological and cognitive deficits. The mortality rate for TBI is 30 per 100,000. Of those who die, 50% do so within the first 2 hours of their injury; this is one reason that there is increased emphasis on treatment at the scene of the injury. The major causes of traumatic brain injury are: motor vehicle crashes (64%), gunshot wounds (13%), falls (11%), assault (8%), pedestrian injuries (3%) and sports injuries (1%). Firearm related incidents account for 40% of TBI deaths; motor vehicle crashes accounted for 34% of fatalities, and falls about 10%. The average lifetime cost of care for a person with severe TBI ranges from $600,000 to $1,875,000. Each year, there are 2,000 new cases of "persistent vegetative state" in the United States as a result of brain injury.
Types of Traumatic Brain Injuries
Not all blows or jolts to the head result in a TBI. Levels of brain injury are rated by the Glasgow Coma Scale. Mild traumatic brain injury occurs when loss of consciousness does not occur or occurs very briefly. Moderate traumatic brain injury occurs when loss of consciousness lasts a few minutes to a few hours. Severe brain injury occurs when unconsciousness or coma lasts days, weeks, months, or longer. The most common type of TBI is a concussion. Other types include penetration injuries (bullets or other objects entering the skull), contusions (bleeding that results from blows to the head), or from diffuse injury (tearing of the brain tissue, as seen in shaken baby syndrome). Repeated mild TBIs occurring over an extended period of time (months to years) can result in cumulative neurological and cognitive deficits. Whereas, repeated mild TBIs occurring within a short period of time (hours, days, or weeks) can be catastrophic or fatal.
Signs and Symptoms of a TBI
The signs and symptoms of a TBI can obvious or very subtle. Symptoms of a TBI may not appear until days or weeks following the injury; they may even be missed as people may look fine even though they may act or feel differently. A person with TBI may exhibit immediate or deferred symptoms.
Physical Symptoms Include:
- Persistent headaches or neck pain
- Full or partial paralysis, problems moving, weakness, or poor coordination
- Spinal fluid leaking from the ears or nose (watery looking fluid)
- Seizures (also called traumatic epilepsy)
- Slow breathing rate, increased blood pressure, slow pulse rate
- Respiratory problems
- Blurred vision, seeing double, tired eyes, and sensitivity to light or blindness
- Ringing in the ears
- Speech difficulties
- Difficulty swallowing
- Vomiting
- Numbness or tingling
- Feeling lethargic
- Loss of sense of smell or taste
- Tremors, shaky hands, spastic muscles, or loss of muscle tone
- Dramatic changes in motor skills
- Speech difficulties
- Sleep problems
- Changes in sexual functioning
Traumatic brain injuries can cause epilepsy, and increase the risk for both Alzheimer's and Parkinson's diseases and other brain disorders associated with increasing age.
Cognitive Symptoms Include:
The most frequent cognitive impairments include: memory, attention, concentration, word finding, planning, judgment, decision-making, and organization difficulties. Deficits in language use and visual perception are also common. Frontal lobe injuries result in problems related to the executive skills of the brain which include: problem-solving, abstract reasoning, insight, judgment, planning, information processing, and organization. There may be a partial or complete loss of reading and writing skills, as well as language problems, including communication deficits and loss of vocabulary.
Psychiatric, Personality and Behavioral Symptoms Include:
Mood disorders are the most frequent psychiatric illness observed among patients with a TBI. Approximately ½ of patients with a TBI will develop a mood disorder at some time during the first year after injury. Psychosis may develop as a result of trauma and blunt force to temporal and/or frontal lobes of the brain; leading to hallucinations and paranoid ideation. Anxiety disorders occur in a significant proportion of patients with a TBI. Posttraumatic stress disorder (PTSD) is another frequent psychiatric complication in patients with traumatic injuries.
Personality and Behavioral Changes may be subtle or severe. Depending on the location and severity of the injury, different types of behavioral disturbances can occur. These include irritability or frustration, impulsivity, a decreased ability to initiate responses/interactions, social disinhibition, agitation, decreased motivation, poor self-regulation of behavior, shallow self-awareness, poor judgment and insight, excessive risk taking, and aggression. Aggression can range from mild verbal abusiveness to physical assaultiveness. Individuals may have difficulty related to their social skills, and may not be able to empathize with others. They may overreact to situations; or cry or laugh inappropriately. Some individuals want to be alone or away from others, and may blame others for everything. These changes can impede treatment and put a strain on all relationships.
TBIs and Incarceration
Many prison and jail inmates have had traumatic brain injuries that frequently complicate their management and treatment while incarcerated.
According to the CDC's jail and prison studies:
- 25-87% of inmates report having experienced a head injury or TBI.
- Inmates who reported head injuries are more likely to have disciplinary problems during incarceration.
- Inmates with head injuries have an increased risk for seizures, mental health problems, suicidal thoughts and/or attempts.
- Inmates with one or more head injuries have significantly higher levels of alcohol and/or drug use during the year preceding their current incarceration.
- Female inmates, who are convicted of a violent crime, are more likely to have sustained a pre-crime TBI and/or some other form of physical abuse.
- Children and teenagers who have been convicted of a crime are more likely to have sustained a pre-crime and/or some other form of physical abuse.
Within the correctional setting traumatic brain injuries can contribute to situations that may lead to disciplinary action. Attention deficits may make it difficult for the inmate with TBI to respond to directions given by a corrections officer, leading to an impression of deliberate defiance on the part of the inmate. Memory deficits can make it difficult to understand or remember rules or directions, the inmate may need to have the rules repeated regularly, slowly, and step by step.
Interviewing a Suspect, Victim or Witness with a TBI
While individuals who have suffered a traumatic brain injury may have impairments in physical, psychological, and cognitive abilities; it is simply a myth that a person with memory impairment lacks intelligence.
The Brain Injury Foundation offers the following tips for communicating with a TBI:
- Reduce noise and distractions that may impede the person's thought processes.
- Use simple language and speak in a low and firm voice.
- Ask one question or give one directive at a time, repeat after 10-15 seconds.
- Be aware of conceptual or language difficulties, especially related to time or distances.
- Avoid jargons and figures of speech.
- Avoid questions about time, complex sequences, or reasons for a behavior.
- Ask what the person may have been doing before the incident occurred to guage time factors.
- Allow the person to write information down and then sort it into a logical order due to sequencing difficulties.
- Allow the person to tape the interview or take notes for better recall.
- Be patient as the person may present information in a tangential or roundabout manner.
- Make sure that you establish the time and place of further appointments and that the person writes this information down, because he or she may have initiation and recall difficulties.
- Ensure that a victim gets an opportunity to rehearse any court room procedures thoroughly.
Conclusion: Stay Safe
Despite a decrease in TBIs related to violence over last two decades, it remains the second leading cause of death in the US. Within this time period, violence related deaths have surpassed motor vehicles crashes as the leading cause of TBI related death. This change may be related to improved safety measures decreasing the incidence of motor vehicle crashes. Nine out of 10 people with a firearm-related TBI die. Most TBI injury accidents occur on weekends and in the night time hours. A person not wearing their seatbelt is 8.4 times more likely to sustain a traumatic brain injury with loss of consciousness in a vehicle collision. For officers who work on a bike patrol remember that a properly fitted bicycle helmet reduces the risk by 85% from having a head injury if you happen to fall off of your bike.
Your goal is to go home tonight, alive and uninjured; be careful out there.
