Brain Injuries and Mass Casualty Events:Information for Clinicians

Traumatic Brain Injury Facts

•The severity of a TBI can range from “mild,” i.e., a brief change in mental status or consciousness, to “severe,” i.e., an extended period of unconsciousness or amnesia after the injury.

•In disaster events, such as the World Trade Center attack or the Oklahoma City bombing, TBIs can be caused by flying debris, falls, being trampled, or blast waves from an explosion.

•In the chaos following mass casualty events, diagnosis of a TBI may be missed.

•Timely diagnosis and treatment of long term consequences of a TBI is needed.

Signs and Symptoms of a TBI

The signs and symptoms of a TBI can be subtle. Symptoms of a TBI may not appear until days or weeks following the injury or may even be missed as people may look fine, even though they may act or feel differently. The following are some common signs and symptoms of a TBI:


•Sleep disturbances
•Problems with emotional control
•Loss of initiative
•Problems related to employment, marriage, relationships, and home or school manage


•Uneven gait
•Blurred Vision


•Attention difficulties
•Concentration problems
•Memory problems
•Orientation problems


Diagnosing a TBI can be a challenge because symptoms are often common to other medical conditions, and the severity of the symptoms can change over time. Any patient with a history of head trauma who is suffering from confusion, disorientation, amnesia of events around the time of injury, loss of consciousness of 30 minutes or less, neurological or neuropsychological problems, or who has a Glasgow Coma Scale (GCS) score of 13 or higher, may have a TBI. Taking a careful medical history can be key to detecting an TBI. Any unusual or unexplained signs or symptoms should be evaluated further.


Treatment of a TBI varies from person to person. Educating the patient and his/her family about the possibility of a TBI and the symptoms that may be experienced as a result of such an injury is critical. Referral to specialists in neurology, neuropsychology, or rehabilitation may be appropriate.