Concussion/Head injury

[Guest buffjock]

Any Flt Docs,

About two weeks ago, I suffered a concussion from an ATV accident. Short-term mem loss (remember going to bed night before, that's it), puking (about 5 min after), and a bad-ass head ache were my symptoms. felt groggy and out of it over the next couple of days, but i am feeling better now. what are the repercussions if i report this? does this prevent me from flying (i am on PRP)? any info you can give me is greatly appreciated. thanks.

-smoke

[ 31. October 2006, 12:43: Message edited by: buffjock ]

[brabus]

A dude I used to work with (just PCS'd) had an accident several months ago...he had a "head injury," but never lost conciousness. He was automatically DNIF'd for 5 yrs. Apparently he can go to Brooks in 2 yrs to get a checkup and POSSIBLY be put back on flying status. According to him, he was told any head injuries require an auto-DNIF for 5 yrs. I'm not a doc, but this is what happened to him...sounds like a very similar situation to yours. Just some info for you to think about.

[Guest P27:17]

I don't know the full repercussions if you "report it"...could just need some testing, and a waiver with very little down time if it's deemed a mild head injury, could take 2 years if it's moderate (if you didn't go to the hospital to get it checked out, you will likely have to wait the full 2 years...it could have been only 6 months if you had a normal CT scan with in 2 calendar days of the injury). The 5 year rule is for head injuries deemed severe.

Now the question (bigger one?)is, What if you have some serious stuff going on, try and "shake it off" so to speak, get into the cockpit, and have some sort of major incapacitation incident...what would the repercussions be then?

I hope you aren't flying anywhere near my house...

[Guest migkilr]

I think that rule is BS (if it actually exists) I just happen to "know" someone who races motorcycles and currently flies F-15s. "He" is quite familiar with concussions. "He" consulted his flight doc once after a concussion and the flight doc recommended a week off from flying and with no adverse symptoms go ahead and fly. Seemed to work out fine. I have a lot of friends who have been bumped on the head a few times and none of them have random episodes of unconciousness or any other strange phenomenon.

That being said, I know they could probably ground you as long as they want. So Buff, I'd keep it to yourself, if you think you need to see a doctor then go see one, I'm sure you can make that decision on your own. Oh, and you can fly over my house anytime.

[Guest doctidy]

Originally posted by migkilr:

...

That being said, I know they could probably ground you as long as they want. ...

Now that's BS.

Flight docs can't just ground people if they're in a bad mood. Someone does that, not only would they have administrative problems (ie-your commander calling their commander), but we would put a note in their credentials file.

Making these types of decisions is the practice of Aerospace Medicine. Making bad Aerospace Medicine decisions is like prescribing the wrong medication...its malpractice.

Like P27 wrote...it depends on the severity of the head injury. Loss of memory and vomiting are signs of a pretty serious head injury. You see football players getting their bell rung...do you see them going back on the next sequence of downs after they have been vomiting on the sidelines?

[Guest migkilr]

Yeah Rage there is a right way to do it (and it sounds like you would do it right), I guess I was just commenting on the guy that didn't even go unconcious and got grounded for 5 years. There may have been extenuating circumstances or this may not be the whole story. But if it is true, that's what worries pilots like me. My flight doc was willing to work with me and not ground me. I can attest to the fact that you can have several significant concussions (including taking the occasional nap) and still be able to fly a jet. It would be a crying shame if I got grounded for 5 years. For the record I've also had a few broken bones and an appendectomy and was kind of surprised at how early they RTFS'd me! It would probably be better if I played golf, but that's just not my thing... Head injuries do have a stigma though. Rage, maybe you could fill us in on some med data to support this, as in what are the incident rates of guys that have had concussions that experience random episodes of incapacitation (beyond the initial headache, vomiting etc.) that would affect their ability to fly.

[Guest P27:17]

migkilr, here is some aeromedical information that may help put this into perspective. Concussions can be a very loose term and do not in any way speak to the total severity of the head injury. Many of us have had our senses knocked around during sports or accidents...but as you can see below, the aviation medical community does not arbitrarily ground someone who has a head injury. There are some real safety for flight concerns that must be addressed before giving the keys back to the plane.

II. Aeromedical Concerns. The decision to return an aviator to the cockpit must be based on the probability of developing serious sequelae, namely motor or neuropsychological deficits, or post-traumatic seizures (PTS). It has been demonstrated that even minor head injury can result in lasting, often subtle deficits, which can lead to failure in the cockpit. Mild intellectual deficits may be missed on a detailed neurological exam, and a good neuropsychological assessment combined with reports from perceptive relatives or friends may be the best tools for detection. For this reason, all rated aviators experiencing even mild head injuries must have cognitive testing prior to return to flying. Screening data obtained prior to UPT is often helpful in this regard in providing a baseline to which this testing may be compared.

Risk of seizure is much more difficult to quantify, but is of critical importance due to the implications for sudden incapacitation. The overall risk of PTS after closed head injury is 1-5%. If a seizure occurs within the first week post injury, the risk of further seizures is 25%. When seizures do occur, 27% occur within the first 3 months, 56% within the first year, and 70% within 2 years. The risk of PTS is substantially reduced if 2 years have elapsed after the head injury but in 30% PTS develops several years after the injury.

It is desirable to know what factors involved in the head injury are associated with increased PTA risk. However, studies that have attempted to identify risk factors are limited and difficult to extrapolate to the flying population. In the general population, several risk factors seem to be associated with greater risk. Intracranial hemorrhage, particularly subdural hematoma combined with cortical contusion, is the worst prognostic indicator, with the combination carrying a 31% risk of PTS. A duration of unconsciousness of >24 hours or depressed skull fracture also increase the risk, but not greatly unless associated with other abnormalities.

III. Information Required for Waiver Submission.

Head injury associated with any of the following is not waiverable:

1. Post-traumatic seizures (exception: seizures at the time of injury)

2. Persistent neurological deficits indicative of significant parenchymal CNS injury, such as hemiparesis or hemianopsia

3. Evidence of impairment of higher intellectual functions or alterations of personality as a result of injury

4. Cerebrospinal fluid shunts

5. Persistent post-traumatic sequelae, as manifested by headache, vomiting, disorientation, spatial disequilibrium, personality changes, impaired memory, poor mental concentration, shortened attention span, dizziness, altered sleep patterns, or any findings consistent with organic brain syndrome are disqualifying, but may be considered for waiver when full recovery has been confirmed by complete neurological and neuropsychological evaluation

Minimum observation periods and evaluation requirements are listed in Table 16.1 of AFI 48-123. Waiver criteria vary depending on the category of head injury under consideration and the classification of the aviator:

Minimal: No waiver is required. A complete neurological examination by a flight surgeon will suffice.

Mild: FC II requires complete neurological examination by a flight surgeon and administration of neuropsychological testing as directed by ACS Neuropsychology as soon as possible. If the neuropsychological testing is normal, the aviator may obtain a waiver for FCII duties. If neuropsychological testing is abnormal, additional more extensive neuropsychological testing will be required and an ACS evaluation may be necessary. A history of seizure within 5 minutes of the injury (without recurrence) may be considered for waiver. FC I and III only require a neurological exam by a flight surgeon.

Moderate: FC II requires complete neurological evaluation by a neurologist, CT scan (preferably obtained within 48 hours of the injury), MRI, EEG (with sleep samples), and neuropsychological testing as directed by ACS Neuropsychology. Examinees may be considered for a FC II waiver after 6 months if the only abnormality placing the injury in the moderate category is duration of LOC/PTA and a CT of the head obtained within 48 hours of the injury is normal. Therefore, it is important to get a CT at the time of injury to permit this exception. Otherwise, the observation period is usually 2 years. ACS evaluation is necessary at 6 months post-injury regardless of whether a waiver is likely to be granted at that time. FC I, IA, III require complete neurological evaluation by a neurologist or internist, CT scan, and neuropsychological evaluation consisting of the following tests, as a minimum: MMPI, Halstead Reitan, and WAIS-R.

Severe: FC II requires complete neurological evaluation by a neurologist, a CT (preferably obtained within 48 hours of the injury), MRI, EEG (with sleep samples), and neuropsychological testing (tests as in category 3). An ACS evaluation is required at 6 months with reevaluations at 2 and 5 years as necessary. Examinees may be considered for waiver after 2 years if the only abnormality that placed the injury in the severe category is duration of LOC/PTA or a small epidural hemorrhage not associated with focal neurological findings. FC III requires complete neurological evaluation by a Neurologist, CT Scan, and neuropsychological evaluation consisting of, as a minimum: MMPI, Halstead-Reitan, and WAIS-R. Severe head injury is generally not waiverable for FC I, but may be considered after 10 years.

IV. Waiver Considerations. There are 407 rated aviators in the USAF waiver files with the diagnosis of head injury. Of these, 44 were disqualified from flying duties. The majority of those disqualified were in the moderate and severe categories.

[ 04. November 2006, 21:11: Message edited by: Toro ]

[Guest Mathew]

Hello,

I am an enlisted flyer and have a serious question regarding a head injury I experienced about 2 weeks ago. I fell down some stairs and hit my head on a tile floor. I did not lose any consiousness. Nor, did I have a major headache. I went to sleep that night without any complications at all. However, I woke up the next day and threw up about 4 to 5 times over a period of 10 hours. The last two times I threw up, I had blood coming out. I was admitted to the hospital that night. After a brain scan, I was diagnosed with blood contusions and clots. Consequently after the diagnosis, I had to go in for surgery (left frontotemporal craniotomy for evacuation of acute left epidural hematoma). I was in the hospital for a total of 4 days, and then released.

Here is the million dollar question........

What are my chances of flying again? Will I have to wait for a period of 5 years before I am allowed to resume flying? If I were to show that my cognitive assessments are fine, not to mention any other after effects(other than the healing period from the injury and surgery) would I be able to fly within a year?

Thanks for any help!

P.S. I am in the guard.

[brabus]

My old boss (pilot) was hit by a car last year at some point and did not lose conciousness, but suffered a concusion and lost his sense of taste/smell (apparnetly it was coming back, just slowly). Either way, according to him, any head injury (and I assume ESPECIALLY one that required surgery) is an auto 5 yr DNIF. He said that after 2 yrs they would be willing to give him an exam at Brooks and then return to flying status if all that checked out good. So, basically it sounds like 2 yrs in the min the AF will let you off DNIF after a serious head injury. I know the docs here can give better info, but at least based on what happened to this dude, sounds like you're SOL for 2 yrs until you can get to Brooks for a check.

[Guest F16PilotMD]

Unfortunately, your head injury is "severe" by the reg:

A4.24.1.6.2. Severe head injury. Head trauma associated with any of the complications listed below may be considered for Flying Class II and III waiver in 5 years (see AFI 48-123V4, Table 1.2.1.).

.

A4.24.1.6.2.7. Epidural, subdural, subarachnoid, or intracerebral hematoma. NOTE: A small epidural collection of blood found only on CT-scan or MRI, and without evidence of parenchymal injury either on the imaging study or on neurological examination, followed to resolution without surgery, may be considered for Flying Class II or III waiver at two years as in the moderate head injury group. For SMOD, this finding does not change the minimum observation period for severe head injury as stated in AFI 48-123V4, Table 1.2.1.

Even more unfortunate,

For Severe Head Injury: "Flying Class I, IA: Not waiverable. Exceptions may be granted after a 10-year period of observation."

I think you are out of luck. Stranger things have happened but I don't know how to tell you to proceed. I don't see a valid argument to consider this less than a severe head injury. The reason you had no symptoms at first is because it took some time for the blood to accumulate and build up pressure in your head. That's a pretty classic, textbook chronology of events after this type of injury.

I wish I had better news for you. I'll be happy to follow up with you if there are any more questions.

[Guest Mathew]

Sir,

As grim as it sounds, I thank you for being candid. I too am not sure what my recourse is going to be. I am resting at home for another week before I have to go into work. At least now I have a good idea as to how to proceed when I go in, rather than have false hopes. I will not lose hope till all options have been met. I appreciate all you replies.

[Guest Mathew]

Just a quick update......

Saw the neurosurgeon, 2 days ago. I have been cleared to go back to work (light duty). Of course flying is on hold. Next step in the process is the medical evaluation board. The neurosurgeon has been directed to follow the AFIs as he is writing the letter. He believes that per the AFI (I fall under the severe catagory radilogically speaking, however clinically speaking I fall under the mild catagory.

Because I was on AD status when the injury happened, AD is requesting a complete medical evaluation to determine whether I will be allowed to stay in the military. Once I make it past that, the determination will be made whether I will be allowed to fly again (2 or 5 years).

Physically and medically speaking, I feel like I am coming along really well. I did really well on my cognitive assessment (civilian side), and my physical therapy was cut short because I was improving really well. Usual aches and pains, nothing out of the ordinary. I will keep updating my progress

Thanks!

Edited May 10, 2007 by Mathew

[Guest Mathew]

To the flightdoc....

Any precedence that you are aware of that categorized an individual in the moderate category, even if the AFI calls for severe in my case. The reason I am asking is because my neurosurgeon states that clinically speaking I belong in the mild to moderate category. However, radiologically speaking (according to the AFI, I belong in the severe category). Now, his letter does state that I have recovered remarkebly with absolutely no residual effects (cognitively and physically speaking), no motor or sensory neurological deficits. Also, there was no loss of consciouness, no post traumatic amnesia, and no abnormality on neurological examination. Last but not least "prognosis for full recovery is excellent".

I am hoping to fall in the moderate category (2 yrs removed from flying). It might seem that I might be grasping at straws. However, I certainly hope that his letter holds weight when it goes in front of the MEB.

Any thoughts?

Thanks!

[Guest awfltdoc]

Any thoughts?

"(left frontotemporal craniotomy for evacuation of acute left epidural hematoma)". I don't think its gonna be possible to reclassify from severe to moderate head injury.

[Guest Mathew]

Thanks! Just hoping for the best.

[Guest F16PilotMD]

Seems like you're still looking at 2 yr DNIF for FC II / III. I don't see a way around that.

[Guest Mathew]

Sir,

Considering the alternative, I will take the 2 years. I do realize what the regs call for (in black and white). If I cannot hope for the best (before a decision is made up chain), I might as well give up.

[Guest Mathew]

Sir,

Considering the alternative, I will take the 2 years. I do realize what the regs call for (in black and white). If I cannot hope for the best (before a decision is made up chain), I might as well give up.

Hello again,

I cannot believe how much time has passed by since my injury. Really, time seems to have flown. I have not yet completed 2 years since my injury (30 March '07.) However, I have been cleared by the Flight Surgeon at my base to start the testing process for a 2 year waiver. The following tests have been ordered, per the waiver guide...MMPI, Halstead-Reitan, WAIS-R, Cat scan. More to follow.......

Edited November 13, 2008 by Mathew

[uhhello]

Going to attempt to cross into the FE world this summer. I had a bad concussion back in 98 (high school). Is this going to require a waiver for my flight physical?

[Guest Mathew]

Hello again,

I cannot believe how much time has passed by since my injury. Really, time seems to have flown. I have not yet completed 2 years since my injury (30 March '07.) However, I have been cleared by the Flight Surgeon at my base to start the testing process for a 2 year waiver. The following tests have been ordered, per the waiver guide...MMPI, Halstead-Reitan, WAIS-R, Cat scan. More to follow.......

............Went through the tests mentioned above. Essentially, these tests consisted of an IQ format, long term and short term memory tests, and motor skills. Came thru with flying colors. I realize that really does not mean anything considering I was put in the 5 yr category, with an opportunity to waiver at the 2 yr mark with no guarantees. My package will go up the chain at the end of March. So far all my cat scans (taken @ 6 mos intervals) have come back fine. More updates as I get them.

Edited January 16, 2009 by Mathew

[Guest jload]

............Went through the tests mentioned above. Essentially, these tests consisted of an IQ format, long term and short term memory tests, and motor skills. Came thru with flying colors. I realize that really does not mean anything considering I was put in the 5 yr category, with an opportunity to waiver at the 2 yr mark with no guarantees. My package will go up the chain at the end of March. So far all my cat scans (taken @ 6 mos intervals) have come back fine. More updates as I get them.

Approx 3 weeks from my waiver package being sent up the chain from my unit.

I have a fellow compatriot within my section who was found unconscious, at the bottom of some steps at a hotel. He was diagnosed with a sever concussion. He was consequently put in the severe category. This episode happened a little over 6 yrs ago for him. At the 5 yr mark he put in his waiver package. He was asked to go thru Walter Reed for all his testing, and passed with flying colors. However, his package was kicked over to big blue by the Guard Bureau, and he was told that he would have to go through all the testing again at Brooks(about 2 wks ago). Bureaucracy at it's best..........

He was given a verbal that he would be recommended back to flight status. He is still waiting.

Makes me wonder..............how things are supposed to work for me. Hmmmmmmmm!!!!!

[uhhello]

Did the above tests as well for my waiver. Everything came out fine. Here is to hoping.

[uhhello]

Class III and waiver approved as of today :) Pretty stoked.

[Guest jload]

Class III and waiver approved as of today :) Pretty stoked.

Dude,

C-O-N-G-R-A-T-U-L-A-T-I-O-N-S!!!!!!!!

Just finished my FC III as requested by the Guard Bureau. I wish you the very best. Keep posting!

[Guest jload]

Package went up to the Guard Bureau, back in April. They requested a FC III, which I finished in June. Package is back at the bureau. More to follow.......