1. Head Injury Psychological Services San Antonio Police Department Head Injury Psychological Services San Antonio Police Department

3. Degree of Head Injuries Mild Mild Moderate Moderate Severe Severe Catastrophic Catastrophic Determination is based upon loss of consciousness, PTA, and Glasgow coma scale Determination is based upon loss of consciousness, PTA, and Glasgow coma scale

4. Types of Brain Injuries Focal vs. Diffused -- Focal: Stroke, aneurism, penetration of skull -- Diffuse: -- Open vs. Closed -- Open: More acute trauma -- Closed: Higher risk of brain swelling

5. Mild Brain Injury Seventy-five percent of all brain injuries are in this category Seventy-five percent of all brain injuries are in this category No loss of consciousness or loss of consciousness for less than 15 minutes No loss of consciousness or loss of consciousness for less than 15 minutes A dazed vacant stare right after the injury A dazed vacant stare right after the injury Delayed motor response to questions like touch you nose Delayed motor response to questions like touch you nose Disorientation and foggy memory Disorientation and foggy memory A normal CT scan A normal CT scan

6. Mild Brain Injury Physical symptoms Physical symptoms Fatigue Fatigue Sensitivity to light and noise Sensitivity to light and noise Numbness or tingling in hands and feet Numbness or tingling in hands and feet Ringing in ears or tinnitus Ringing in ears or tinnitus Headaches Headaches Dizziness Dizziness

7. Mild Brain Injury Cognitive Cognitive Difficulty concentrating Difficulty concentrating Increased distractibility Increased distractibility Difficulty reading Difficulty reading Problems with attention and concentration Problems with attention and concentration

8. Mild Brain Injury Mood Mood Depression Depression Anxiety Anxiety Mood swings Mood swings Sleep disturbance Sleep disturbance Irritability Irritability Loss of libido Loss of libido

9. Moderate Brain Injury Unconscious from 15 minutes to 24 hours Unconscious from 15 minutes to 24 hours Balance problems or tremors Balance problems or tremors Seizures Seizures Memory deficits Memory deficits Poor judgment and difficult with problem solving Poor judgment and difficult with problem solving Lack of coordination Lack of coordination

10. Moderate Brain injury Paralysis Paralysis Language problems Language problems Perceptual difficulties Perceptual difficulties Behavioral problems Behavioral problems

11. Severe Brain Injury/Catastrophic Brain Injury Severe Brain Injury Severe Brain Injury Loss of consciousness for more than 24 hours Loss of consciousness for more than 24 hours Initially significant cognitive and motor problems Initially significant cognitive and motor problems Many of these individuals remain under care and supervision of others for long periods of time Many of these individuals remain under care and supervision of others for long periods of time Catastrophic Brain injury Catastrophic Brain injury May remain in coma for months, or years May remain in coma for months, or years Sometimes referred to as a “persistent vegetative state” Sometimes referred to as a “persistent vegetative state”

12. Who To Refer Anyone exposed to or involved in a blast, fall, vehicle crash, or direct impact who becomes dazed, confused or loses consciousness, even momentarily, should be further evaluated for a brain injury. Anyone exposed to or involved in a blast, fall, vehicle crash, or direct impact who becomes dazed, confused or loses consciousness, even momentarily, should be further evaluated for a brain injury.

13. Red Flags Refer for immediate medical evaluation if any of the following are present: Refer for immediate medical evaluation if any of the following are present: -- Double vision-- Seizures -- Breathing difficulties-- Slurred speech -- Headache that worsens-- Unsteady on feet -- Disorientation-- Repeated vomiting -- Cannot be awakened easily-- Weakness/numbness -- Unusual behavior or confusion/irritability confusion/irritability

14. Longer-term Symptoms Impaired balance/motor functioning Impaired balance/motor functioning Postural instability Postural instability Attention/concentration deficits Attention/concentration deficits Memory problems Memory problems Slowed processing speed Slowed processing speed Slowed reaction time Slowed reaction time Impaired executive functioning Impaired executive functioning Higher risk for subsequent concussion for at least the next year Higher risk for subsequent concussion for at least the next year

15. Post Concussion Syndrome PCS criteria in DSM-IV-TR PCS criteria in DSM-IV-TR –History of head trauma –Difficulty with attention or memory –3 or more of the following symptoms, which are present for at least 3 months -- Easily fatigued-- Disordered sleep -- Headache-- Vertigo/dizziness -- Irritability/aggression-- Anxiety/depression -- Changes in personality-- Apathy

16. Management of Brain Injured Individuals Remain calm Remain calm Regulate your voice Regulate your voice Keep communications short simple Keep communications short simple One command at a time may need to repeat commends One command at a time may need to repeat commends If possible explain what you are going to do before you act no surprises If possible explain what you are going to do before you act no surprises Avoid using bright lights reduce noise Avoid using bright lights reduce noise One officer give directions One officer give directions Ask about medications, caretakers, medical personnel Ask about medications, caretakers, medical personnel Redirect their attention Redirect their attention

17. Questions??