In 2005, Patrolman Carl Jackson was in a foot chase in Woodbury City, New Jersey, with a person known to local law enforcement. The suspect was a repeat offender who was known to carry a gun, and who had a warrant out for his arrest. When he saw Carl, he ran.
Carl was a physically fit and determined young police officer who took his oath to protect and serve as a personal mission. And he was good at foot pursuits. Instinctively and expertly, he took off after the fleeing suspect. The two of them hit a six-foot-tall fence, and as Carl fought to keep the suspect from scaling the fence, both men went down hard onto the asphalt. The last thing Carl remembers is the sound of his own head hitting the blacktop, and then the lights went out.
Carl’s Concussion Story
When he came to, Carl found the suspect laying on top of him. His instincts kicked in. He checked to see that his service weapon was still holstered, and he got the guy handcuffed. It took a few minutes before Carl found his portable radio (in the struggle, it flew off, landing about 20 feet from him), and then he called for backup. Other officers arrived, and the suspect was taken to the station. The next thing on Carl’s mind was the less-than-glamorous side of police work: the paperwork. What he did not realize immediately, as happens to officers often in the course of their duties, is that he had been injured.
The Under-Detected Signs of Concussion in Law Enforcement
Carl pressed forward because the job, and the public’s safety, always came first to him. Back at headquarters, Carl noticed something unusual when he open his locker: he couldn’t get the key in the lock until he steadied it with two hands. The next strange thing he noticed while he was writing the report. “I was having trouble making the pen work, and everybody knows how to work a pen,” Carl recalls. It was then a co-worker pointed out that the back of his head was bleeding. Carl was sent to the hospital to get checked, and it was there he was told for the first time that he had suffered a concussion.
A concussion is a type of traumatic brain injury (TBI) that happens after an impact to the head or body and causes the brain to jostle back and forth, leading to possible chemical changes and damage to the brain cells. Concussions can range from mild to severe, but even a mild concussion can result in long-term or severe symptoms. When the back of Carl’s head hit the asphalt, his brain hit the inside wall of his skull and was bruised. “It sounds like his injury, the concussion, had an immediate impact and effect on his ability to unlock his locker and make a pen work to write his report,” says Mid-Atlantic Concussion Alliance Medical Director Vincent E. Schaller, MD, DABFM, CIC.
Some of the signs of a concussion can include:
- Headaches
- Short-term memory loss
- Difficulty concentrating
- Sensitivity to light or noise
- Nausea or vomiting
- Sadness or anxiety
- Fatigue
- Insomnia
- Loss of consciousness (not always)
- Clumsiness or troubles with balance
Post–Concussion Syndrome in Law Enforcement
Within 24 hours of sustaining his concussion, Carl reported experiencing a seizure and feeling extreme fatigue. But instead of clearing up after a few days or weeks, mini-seizures and bouts of fatigue would go on for years. And loud noises, flashing lights and extreme heat would trigger migraines. At social gatherings, like weddings, he’d often slip outside to a quiet parking lot while his wife enjoyed the party. He would go on to develop speech and memory difficulties too. While always soft spoken, Carl became a guy too embarrassed to even speak at all.
When the symptoms persist long after the concussive incident, the condition is called post-concussion syndrome (PCS). Often called “invisible injuries,” concussions don’t always have signs and symptoms that are immediately apparent. “We have to do a better job educating the public about what concussion signs and symptoms look like, and about how long they can go if they are severe or untreated,” says Dr. Schaller.
On-going symptoms of post-concussion syndrome or other TBIs can include:
- Migraines
- Seizures
- Fatigue
- Vision problems
- Memory impairment
- Mental health issues, such as depression and anxiety
In addition, sometimes symptoms can show up weeks or even months after the concussion occurred.
Traumatic Brain Injuries, Mental Health Issues and Cops
After months of doctors’ visits, occupational therapy and MRIs, it became painfully clear: Carl wouldn’t’ be going back to the job that was his calling. His was suddenly retired.
“It makes you feel a sort of survivor’s guilt knowing the cops I worked with were still out there patrolling, and I was getting out early,” he says. He was angry and depressed and felt that he had, in his words, “retired in shame.”
Depression is a very real and debilitating post-concussive symptom, but it’s a subject not often spoken about among cops. “A police officer who is forced to retire early can lose their social circle and feel shame from leaving the job early, which can just add to the risk for depression after their TBI,” says Dr. Schaller. “This can have a devastating effect on patients and their families.”
A somber reminder of what is at stake, a 2019 study reported in JAMA Neurology found that “the risk of suicide was two-fold higher for people diagnosed with at least one concussion and/or mild TBI (traumatic brain injury) compared with those not diagnosed with a concussion and/or mild TBI”.
Tony’s Concussion Story
One February not too long ago brought a couple of really snowy days to the Northeast. Tony (who asked that we use a pseudonym for this story) and his police department were handling a lot of service calls as the snow kept coming down. Out at a four-car motor vehicle crash scene, Tony was blocking traffic lanes with his police cruiser to give tow trucks a safe space to work. It was all pretty routine, as these calls go.
Police, Car Crashes and Concussions
Tony remembers seeing a car in his rearview mirror that was swerving in the snow storm. It was moving fast and headed directly for him. He braced for the impact.
His next memory is standing on the side of the road after other officers at the scene pulled him from the wreckage. He was later told the swerving car was traveling at 70 miles per hour when it hit the back of his cruiser.
At the hospital, a doctor told him that he may have had a concussion. Tony was advised to go home and rest. By morning he was vomiting and dizzy and had the worst headache he had ever experienced. He couldn’t get out of bed for an entire day. His wife took him to see a doctor at an urgent care center, where Tony was diagnosed with a traumatic brain injury, and a course of treatment was set up for him.
“MRIs and CAT scans won’t detect even the most severe concussions. They are helpful in diagnosing skull fractures or brain bleeding post-head injury, but not concussions,” notes Dr. Schaller. “There are better diagnostic tools for concussions and TBIs, but not a lot of ERs or urgent care centers have them. We often get patients referred to us from these medical facilities when they suspect a concussion.”
Navigating Workers’ Comp After a Concussion
Just a few months after the crash, Tony was told by the workers’ compensation insurance doctor that he was clear to return to work. However, Tony was still experiencing headaches, nausea, dizziness and issues with focusing—all symptoms of PCS. As he continues critical recovery treatment from his brain injury, he also faces the challenges of fighting for his benefits so that he can provide for his family.
Dr. Schaller says this is all too common with workers’ comp health assessments because those conducting them are not always up-to-date on concussions. In addition, the process of appealing and being forced to prove you are still injured to insurance companies can be overwhelming and demoralizing for TBI patients. This can be especially hard on police officers already struggling with their “new normal”.
“I used to feel invincible because that’s how cops feel,” says Tony. “The traffic would fly right past my legs while I was making stops, and I wouldn’t give it a second thought. We’re trained to be fearless.”
Tony is also still waiting to receive his accidental disability retirement for being injured in the line of duty.
Making His Way Down the Road to Recovery
These days Tony knows he’s not the same. Migraine triggers, like bright lights and tracking fast movement with his eyes, make watching sports on TV a challenge. He currently can’t multitask or drive. And he “snaps easily” at people when he used to be an even-tempered guy. He also knows that he suffers from post-traumatic stress disorder (PTSD), which can result after a concussion, according to the British brain injury association Headway. Undaunted, Tony is working on managing his PTSD along with his post-concussive treatment.
The Reality of Unaddressed Concussions in Law Enforcement
Concussions in law enforcement was the topic of an insightful May 2021 opinion piece in Roll Call by Michael Wyand, DVM, PhD, CEO of Oxeia Biopharmaceuticals, a company currently conducting phase two clinical studies for a therapeutic drug to treat concussions. The essay noted:
Concussions and other injuries sustained by law enforcement at the Capitol on Jan. 6 garnered national headlines. While much of the national dialog surrounding concussions over the past decade has focused on athletes, concussions, also known as mild traumatic brain injuries or mTBI, are a daily hazard faced by first-responders across the country.
While we know that car crashes, foot pursuits, physical assaults, house fires, severe weather events and other work activities put police at risk for concussions, little research exists into the frequency or severity of TBIs in law enforcement. Here is what we do know:
- A small pilot study in 2020 in the Journal of Psychiatric and Mental Health Nursing of 54 police officers from a Midshire Police Constabulary in Britain found that mild TBIs with a loss of consciousness were reported by 38.9% of those surveyed, and that post-concussion symptoms were associated with greater severity of PTSD, depression and drinking alcohol to cope.
- The U.S. Bureau of Labor Statistics (BLS) reported in 2018 that police officers are four times more likely to sustain a work-related injury than all other civilian occupations. (The BLS does not have a separate statistical count for concussions or TBIs.)
- In a 2016 report to Congress the Centers for Disease Control and Prevention (CDC) showed an estimated 2.5 million new reported cases of traumatic brain injuries annually.
The TBI and PTSD Law Enforcement Training Act (H.R.2992)
Dr. Wyand urges support and passage of H.R.2992: TBI and PTSD Law Enforcement Training Act in Congress. According to the BIAA, the bill would require the CDC to conduct much needed study on law enforcement and first responders who have suffered a traumatic brain injury. It would also provide for training for these professional on how to better interact with people in the general public who have TBIs. The bill’s sponsors include Congressional Brain Injury Task Force (CBITF) Co-chairs Reps. Bill Pascrell, Jr. (NJ) and Don Bacon (NE), as well as Reps. John Rutherford (FL) and Val Demings (FL).
We also support this legislation, as it will be a major step in the right direction towards helping officers like Carl and Tony receive the support they need and deserve.
Carl’s Story Is Far From Over
Carl knows the worst of his injury is behind him, but it’s never fully gone. True to his nature, he is using his own experience to help others in a new capacity. He does vital volunteer work in support groups and helps staff a mental health hotline for police officers called COPLINE. The journey hasn’t been easy, but Carl has created a new life for himself that is different than what he thought it would be before his injury, but still meaningful and valuable.
Resources for Law Enforcement Officers with Brain Injuries
January 9, 2022, is National Law Enforcement Appreciation Day. MAC Alliance would like to thank all who protect and serve our communities.
Below are some resources for law enforcement professionals and their families:
- 1-800-COPLINE (1-800-267-5463) is a hotline available 24/7/365 and staffed by retired law enforcement officers to provide support and resources for officers coping with PTSD and other major stressors in their lives. Their website is copline.org.
- Brain Injury Association of America (BIAA) is non-profit organization with chapters across the country providing support, advocacy and resources for individuals with brain injuries. Their website is biausa.org.
- The CDC Traumatic Brain Injury and Concussion web site (cdc.gov/traumaticbraininjury) provides brain injury information for patients, professionals, family caregivers and the community.
