Picture 1: Static-line drop with EPC. Diagnose a concussion There is no current consensual definition of the concus- sion. In order to diagnose, we will remind three major definitions: one from the Mild Traumatic Brain Injury Committee (mTBI) from the American Congress of Rehabilitation Medicine,12 the standards from the International World Health Organization Task Force on Mild Traumatic Brain Injury13and the definition of the American Psychiatric Association in its fifth version of Diagnostic and Statistical Manual of Mental Disorders (DSM - V) . The different authors agree to diagnose a14 concussion on a patient suffering from a cranial trauma, direct or not, getting a Glasgow score from to 13 to 15, 30 minutes after the event and presenting at least one of the following standards: - Initial loss of consciousness inferior or equal to 30 Static line remains the main tactic used by the French minutes; army. It allows dropping many paratroopers from a low - A post-trauma amnesia inferior to for less than 24 altitude and guarantees surprise effect during opera- hours; tions. Considered a “risked activity”, static line is respon- - A state of confusion or disorientation; sible for a significant number of injuries in the armed - A transitory focal neurological deficit. forces and presents a specific traumatology1, 2. Landing is the most dangerous phase in the drop, causing 75% of The diagnosis of a concussion is clinical. Some tests may the injuries.3 Main risk factors are known as3, 4: wind be used to confirm this diagnosis,but they cannot speed, night dropping, dropping with a heavy load, ope- replace the diagnosis of a clinician. rational drops and the nature of the landing area (harsh ground, obstacles, etc.). Complications Most concussions appear to resolve with a 7 to 10 days However, the incidence of paratrooper’s trauma long resting time; yet complications can appear in a appears to be constant in most countries, with a rate of short, medium, or long term.15 10 for 1000 drops using static lines1, 3-6. In France, this incidence has felt to 6.7 for 1000 drops with the new The post-concussion syndrome isdefined by the paratrooper’s equipment. While leg’s lesions are the2 conjunction of at least three remaining symptoms one most common injuries, the cephalic area is not spared.4 month (CIM 10)16or three months after a concussion. Closed cranial trauma represents up to 30% of the These symptoms may be somatic, cognitive, or beha- lesions in Knappick’s 2011 study. This study brings out3 vioral. In the scientific literature, 15% to 25% of the the vulnerability of the cephalic area during a drop sufferers of mild traumatic brain injuries could develop with automatic parachute opening. a post-concussion syndrome17-18 . Concussion may be long ignored by the sufferer or The major hazard in concussion lays in its possible repe- considered as a mild injury with an easy resolution tition that may be the cause of two complications. through rest. Following the numerous injuries and deaths during football and hockey competitions, a In a first part, the second impact syndrome is defined renewed interest focused on this pathology. Since by the early coming of a second concussion for a 2000’s, numerous international articles have been patient whose remission is not complete. Clinically, this published and updated.The fifth Berlin’s consensus syndrome is characterized by impaired consciousness conference in 2017 was to standardize and facilitate7 and vigilance up to a quick death. After a concussion, the diagnosis and the treatment of concussion. This there might be a period of brain vulnerability.If a pathology is now regarded as a public health’s matter second impact rapidly occurs, the brain’s hemodynamic is in the USA. Estimating its prevalence is complicated, changed with the incoming of both a intracranial hyper- but every year from 1.6 to 3.8 million athletes could tension and a cerebral edema up to cerebral herniation. suffer of this injury8, 9. Concussion is characterized by a sudden brain’s dysfunc- ∑179èmeantenne médicale de Tarbes. tion with neurological transitory symptoms. It is caused ∏CMIA Saint Denis, by a force directly applied to the cephalic area, or to any Antenne médicale de Saint Pierre. other part of the body directly connected to the brain. πDirecteur des études écoles militaires de santé Lyon Bron. Most of the time, the symptoms resolve by themselves in Correspondence: a duration from a few hours to about ten days. However, Med Manon MASSIT Médecin Adjoint, the repetition of the constraints before the symptom’s 179èmeAntenne médicale de Tarbes, resolve creates a cumulative effect on the cerebral mal- 65000 Tarbes, France, VOL. E-mail: manonmassit@gmail.com 94/3 function and may be the cause of complications7, 10 . International Review of the Armed Forces Medical Services 19 Revue Internationale des Services de Santé des Forces Armées