Understanding PTSD and TBI


Why this is important to you and the Wounded?


Suggested responses for dealing with the Wounded


Delivering Psychological First Aid

*The SSFOA highly recommends the Crisis Intervention Team program started by the Memphis Police Department in 1988 who joined in partnership with the Memphis Chapter of the National Alliance on Mental Illness (NAMI), mental health providers, and two local universities (the University of Memphis and the University of Tennessee) in organizing, training, and implementing a specialized unit. This unique and creative alliance was established for the purpose of developing a more intelligent, understandable, and safe approach to mental crisis events.

This program trains officers to recognize mental issues and teaches de-escalation techniques. While the SSFOA does not consider PTS a “mental” illness, many of the techniques used are applicable to those wounded with PTS.

Many of the same symptoms can be displayed for both wounds, PTS and TBI. This is often the reason why the diagnoses are found with one and then later the other.

PTS(D) is nothing to be ashamed of, embarrassed by,
feel guilty about or laughed at.

PTS(D) -- Post Traumatic Stress
known as PTSD or Post Traumatic Stress Disorder. SSFOA feels that PTS(D) is not a disorder but is a
wound that affects thousands of servicemembers and their families. We believe PTS(D) sufferers should be treated with the same respect, care and honor as all wounds and illness receive.

Basically, Post Traumatic Stress is unconscious, automatic physical, emotional reaction(s) brought on by a delayed reaction to severe physical and psychological experiences that are outside the normal human range of emotions. Veterans of combat are the most publicized group of sufferers.

But law enforcement officers; emergency medical personnel; firefighters; survivors of life threatening accidents, fire, flood or natural disasters; victims of violent crime; and victims of domestic, child or sexual abuse can and do suffer from PTS(D). ANYBODY can be affected by PTS(D). Even family members and friends of those who have PTS(D) can suffer from what is called Secondary Traumatic Stress Disorder (STSD). It is believed that 7-8% of the population have PTS(D) at some point in their lives.

The following behavior/reactions are contributed to the affects of PTS(D) (not a complete list, each person reacts differently and a
person's reaction is different due to the source of the trauma):

- Flashbacks, or reliving the traumatic event(s) for minutes or even hours
- Feelings of shame or guilt
- Having upsetting dreams about the event(s)
- Trying to avoid thinking or talking about the event(s)
- Feeling emotionally numb
- Irritability or anger
- Poor relationships
- Self destructive behavior - use of drugs or drinking too much
- Feeling hopeless about the future
- Having trouble sleeping
- Memory problems
- Trouble concentrating
- Being easily startled or frightened
- Not enjoying activities that once were enjoyed
- Hearing or seeing things that aren't there

Signs and symptoms of PTS(D) usually show up within 3 months of a traumatic event. However, for some, PTS(D) signs may not occur until years afterwards. Symptoms can come and go.

Usually more symptoms become apparent during times of higher stress or when experiencing symbolic reminders of the event(s). These reminders might be something remembered, something seen, something heard or even something smelled.

There is no one cause of PTS(D) and research is ongoing in this area. As with any mental health issue, the individual's biology and genetics, life experiences, temperament and changes in the natural chemicals of their brains all play a part.

To help those with PTS(D) everyone is encouraged to do the following - general:
- Become aware of what PTS(D) is
- Offer understanding and support to those (along with their family members and friends) who are living with this condition


What is Traumatic Brain Injury?
Traumatic brain injury (TBI), also called acquired brain injury or simply head injury, occurs when a sudden trauma causes damage to the brain. TBI can result when the head suddenly and violently hits an object, or when an object pierces the skull and enters brain tissue. Symptoms of a TBI can be mild, moderate, or severe, depending on the extent of the damage to the brain. A person with a mild TBI may remain conscious or may experience a loss of consciousness for a few seconds or minutes. Other symptoms of mild TBI include headache, confusion, lightheadedness, dizziness, blurred vision or tired eyes, ringing in the ears, bad taste in the mouth, fatigue or lethargy, a change in sleep patterns, behavioral or mood changes, and trouble with memory, concentration, attention, or thinking. A person with a moderate or severe TBI may show these same symptoms, but may also have a headache that gets worse or does not go away, repeated vomiting or nausea, convulsions or seizures, an inability to awaken from sleep, dilation of one or both pupils of the eyes, slurred speech, weakness or numbness in the extremities, loss of coordination, and increased confusion, restlessness, or agitation.


Your personal safety and the safety of by standers is your prime responsibility. Refer to your training. However taking a few simple steps can protect you and the person wounded with PTS.

Remember that the person with combat PTS has fought for his country and if you can defuse a situation without harm to anyone you have served your country as well.


The following is information that may be helpful when dealing with someone with combat related PTS(D) These recommendations come directly from combat veterans.

When in contact with someone who has combat related PTS(D) or you think has it:

- Be calm
- Keep the number of people involved to a minimum
- Do away with unnecessary noise, bright lights
- Do not move quickly toward them
- Be patient
- Speak slowly with frequent pauses
- Avoid interruptions when they are speaking, as they may forget what they are trying to say

Crowds, loud noise, bright lights, fast movement, yelling are all things reminiscent of combat and can trigger a flashback or intensify the situation if the individual is currently experiencing a flashback.

Anything that can be done to keep the conditions affecting the person
with PTS(D) as non-threatening as possible will go a long way in defusing a potential confrontation.

If possible remove sunglasses. Being able to see someone's eyes helps build trust

If there are more than 1 LE/EMS personnel involved, they can loosely circle the individual (just to help contain the situation if the individual attempts to bolt). But do not crowd and have only 1 LE/EMS person talking to him/her.

Delivering Psychological First Aid*

Professional Behavior
Introduce themselves and give their job title.....police, emt, paramedic, etc.

• Model healthy responses; be calm, courteous, organized, and helpful.
• Be visible and available.
• Maintain confidentiality as appropriate.
• Remain within the scope of your expertise and your designated role.
• Make appropriate referrals when additional expertise is needed or requested by the survivor.
• Be knowledgeable and sensitive to issues of culture and diversity.
• Pay attention to your own emotional and physical reactions, and practice self-care.

Guidelines for Delivering Psychological First Aid

• Politely observe first, don’t intrude. Then ask simple respectful questions to determine how you may help. Ask if they know where they are.
• Often, the best way to make contact is to provide practical assistance (food, water, blankets).
• Initiate contact only after you have observed the situation and the person or family, and have determined that contact is not likely to be intrusive or disruptive.
• Be prepared that they will either avoid you or flood you with contact.
• Speak calmly. Be patient, responsive, and sensitive.
• Speak slowly, in simple concrete terms; don’t use acronyms or jargon.
• If the wounded want to talk, be prepared to listen. When you listen, focus on hearing what they want to tell you, and how you can be of help.
• Give information that directly addresses the wounded immediate goals and clarify answers repeatedly as needed.
• Give information that is accurate.
• Remember that the goal of Psychological First Aid is to reduce distress, assist with current needs, and promote adaptive functioning, not to elicit details of traumatic experiences and losses.

Some Behaviors to Avoid
• Do not make assumptions about what wounded are experiencing or what they have been through.
• Do not pathologize. Most acute reactions are understandable and expectable given what the wounded have experienced. Do not label reactions as “symptoms,” or speak in terms of “diagnoses,” “conditions,” “pathologies,” or “disorders.”

The Silver Star Families of America also operate the Law Enforcement Equipment Program

Special thanks to the National Center for PTSD
National Institute of Neurological Disorders and Stroke
Veterans with post-traumatic stress disorder present challenges for the criminal justice systemby Dan Heilman Associate Editor
• As of Sept. 10, 1.717 million U.S. troops have been deployed to war zones in Iraq and Afghanistan.

• About 300,000 have been diagnosed with post-traumatic stress disorder.

• A further 320,000 have been diagnosed with symptoms related to traumatic brain injury. When Hector Matascastillo found himself in an armed standoff with eight police officers on the front yard of his Lakeville home early in 2004, in his mind he was doing what he’d been trained to do, and what came naturally to him: operating on survival mode, with no thought for the context of his actions.

It was only after he was arrested and jailed that Matascastillo, a Bronze Star recipient who served in Iraq with the 75th Ranger Regiment of the U.S. Army, realized first-hand the challenges that veterans face on their return to society, and the precarious position more and more of them find themselves in when they encounter the criminal justice system.

Matascastillo, who now works as a veterans’ employment representative for the state Department of Employment and Economic Development, told a recent seminar sponsored by the Ramsey County Bar Association that some combat veterans have “an addiction to chaos” that can lead to post-traumatic stress disorder. PTSD, in turn, can often lead to conflicts not only within the veteran’s home life, but also with authorities.

“We have a mentality that says there’s nothing we can’t do, and that we have to be on 100 percent of the time,” he said of combat veterans. “We have to be in survival mode.

“One of the soldiers I served with is facing jail time for two DWIs in two months. Another one gets in fights in bars because he can’t stop wanting to fight,” Matascastillo said. “Neither of them was like that before they joined the military.”

A new kind of veteranAdvertisement PTSD — or what used to be called by such less euphemistic names as combat fatigue and shell shock — has been a reality of war for centuries. In “The Iliad,” which dates back to the 8th or 9th century B.C., Homer depicts Achilles’ psychological breakdown during the Trojan War.

But the abolition of the draft has brought about a new kind of veteran, one who is called up for two, three and sometimes more tours of duty. According to experts who spoke at the seminar, the criminal justice system is due for a flood of offenders with military backgrounds unless something proactive is done to get them the help they need.

“We’ve had 1.7 million people deployed in Iraq and Afghanistan, and almost half of them have gone back more than once,” said Minneapolis criminal defense attorney Brockton Hunter, who works extensively with veteran defendants. “About 600,000 of those people have PTSD or TBI [traumatic brain injury], and less than half of them get the help they need. Those are the ones who pop up in the criminal courts.”

Hunter said combat trauma can be linked to criminal behavior in two ways: Symptoms of PTSD can incidentally lead to criminal behavior, or offenses can be directly connected to the trauma the veteran experienced. For example, he noted, hundreds of thousands of Vietnam veterans are homeless, addicted or incarcerated 35 years after the last American troops were brought back from that war.

The numbers from the Iraqi and Afghani wars are shaping up to be even more troubling. Recent figures from the U.S. Veterans Health Administration show that more than half of the veteran patients are being treated for disorders deriving from PTSD and other mental health issues.
“We’ve asked more of [troops serving in Iraq and Afghanistan] than we’ve asked of any force in history,” Hunter said. “To me, the path these people follow is a no-brainer: self-medicate, hair-trigger temper, encounter with police. We will pay the price in the long run.”

Progress in Minnesota

Strides are being made in how the criminal justice system deals with veterans, but, for a number of reasons progress is slow.

For one thing, a veteran’s pride in his military career will often keep him from identifying himself in criminal court, for fear of dishonoring his uniform. Also, because veterans come from a warrior culture, they often see a diagnosis of PTSD as a concession to weakness, so often mental illnesses among veterans go undiagnosed.

“What’s helpful in war isn’t so helpful in society,” said Lt. Col. Cynthia Rasmussen, a mental health nurse in the Army Reserves. “Vigilance in war means being suspicious of everyone. In war, anger is useful and protective. Back here, those mindsets get you in trouble.”

Fortunately, Minnesota is ahead of the curve when it comes to making concessions for veteran offenders. With help from veterans’ advocate Guy Gambill, the state Legislature this year amended a state statute to take into account the mental health status of veterans during the sentencing phase of criminal proceedings.

Now, if a defendant in Minnesota is convicted of a crime, it’s recommended that the court ask if he or she is a veteran. If the defendant is a veteran and has been diagnosed as having a mental illness, the court may consult with the federal or state Department of Veterans Affairs to determine treatment options in lieu of or along with a jail sentence.

The amended bill was unusual in that it had broad, bipartisan support — not only from Republicans and Democrats, but from such naturally contrary bodies as the Minnesota County Attorneys Association and the Minnesota State Public Defenders.

The amended statute was modeled in part on a 2007 California initiative that lets judges depart from presumptive prison sentences in cases involving veterans with PTSD, and, when suitable, order treatment in lieu of jail time.

While the Minnesota bill is somewhat stripped down in that it doesn’t provide for a registration system for veterans with PTSD or for psychological evaluations, it’s a good start, said Gambill.
“We’re in the lead in the country when it comes to this,” he said. “It gives the court treatment options it didn’t have before.”

Hunter said that the military is doing more to screen and treat PTSD. The Veterans Administration is also expanding its treatment capacity, he added.

Rasmussen, who often speaks on behalf of veterans’ issues, said the key to preventing veterans from becoming criminal defendants is to create an understanding that when they come home, they’re entering what has become a foreign world.

“Going off to war is easy,” she said. “Coming home, nobody knows what to expect.”
© Copyright 2008 Minnesota Lawyer. All rights reserved.