Neurotrauma in Naval Special Warfare Combat Crewmen and Fast Boat Operators

Fast boat operators (FBOs) are exposed to thousands of high-G impacts while traveling up to 50 to 60 mph over 1- to 6-foot waves for hours at a time. This represents a potential risk factor for repetitive head impacts and traumatic brain injury (TBI). This study evaluates the burden of neurocognitive symptoms among FBOs and their association with a formal TBI diagnosis.

Two hundred forty-five FBOs were surveyed. The number of months served as an FBO on boat deployments, and the number of respondents diagnosed with TBI during their service were collected. Comparison of exposure and neurocognitive symptom burden between patients with and without TBI was performed through two-sided T-tests and χ2 analyses using Python.

One hundred ninety-eight operators (80.8%) responded. Average age was 51.0 ± 10.1. Average years served as an FBO was 12.1 ± 6.4. Average months deployed on fast boats was 91.6 ± 62.9. Ninety operators (45.5%) were medically diagnosed with TBI. TBI diagnosis correlated with the number of years as an FBO (P = .001), months on fast-boat deployments (P = .004), diagnosis of post traumatic stress disorder (P < .001), and diagnosis of cervical spinal stenosis (P = .016). Multiple linear regression analyzing factors associated with neurobehavioral symptom inventory cognitive domain scores showed that TBI was the only factor associated with increased scores (Beta: 1.08, 95% CI: [0.19-1.97], P = .02).

Our results indicate a significant neurocognitive burden among Special Warfare Combat Crewmen operators; however, compared with the level of symptom burden, relatively few respondents received a formal TBI diagnosis. Physicians caring for FBOs should remain vigilant to ensure that subtle signs of postconcussion syndrome are recognized, return to duty protocols are enforced, and safety measures are adopted to protect FBOs from TBI.