Marco Werman: Well, anyone who’s been on social media probably will have seen boats in the North Sea, for example, coming face to face with giant waves. They crest, and then they slam down. You spent years looking at some of the more obvious injuries that present after each of these wave events: compressed spines, fractures, neck injuries. When did you begin to realize there were also traumatic brain injuries?

Dr. Johan Ullman: That was during our ongoing study, where a survey was conducted on retired Special Forces boat operators from the US Navy Special Forces, 72% of them reported having experienced cognitive effects, difficulties sorting out their work onboard, which was either driving the boat or navigating the boat. And even more surprising was that one-third reported having been unconscious, not from hitting their heads, but from the violent jolt of the head that occurs when you get slammed from below. So, this was about five years ago. We saw these signs and then this article in The New York Times that came out in December 2024 describing a 44-year-old operator who suffered these injuries and experienced so fast-declining cognitive capacity that he chose the ultimate way out. Very, very sad story.

Wow. So, he took his life.

He did. And after this, we hear anecdotes about several people with similar jobs in these agencies having gone the same way, but there are no statistics on it, and there is nothing scientifically published yet. But we believe that what we see now is the tip of an iceberg because this is not something that comes suddenly. We believe it comes from repeated impacts. And the difference between NFL players and hockey players, where these mechanisms have been known and documented for decades, is that the number of impacts the boat operators are exposed to, we believe, is significantly larger than NFL players.

Yes.

So, you’re the lead in this ongoing study with NATO across 15 countries to better understand this. Can you talk more about what you’re trying to figure out?

We are determined to find the answer to what the magnitude of the impacts is, the peak acceleration levels and how fast the acceleration sets in. The faster you go from zero to peak acceleration, the higher the level of kinetic power transmitted to the human body. To find out when the exposure on the boat gets injurious, every subject that participates in this study will get a ping on their phone asking, “Do you have any pain?” So, we use pain as an indicator of injury risk.

Take us to the next step. How will that help to zero in on possible solutions?

When we have this information, it will be very easy to give the coxswains relevant real-time information about when it’s time to slow down. So, it’s about slowing down.

Can’t you retrofit the boats to lessen the impact of these wave crashes in any way?

There is a lot you can do with the boats. You can improve hull shapes. You can improve driving skills. You can fit ride control systems that keep the boats level. And you can fit suspension seats, which take up large portions of the impacts. But regardless of all measures taken, you will always be able to drive a boat in a way that becomes dangerous.

Doctor, you’ve interacted closely with these mariners for years. What are you hearing from them? What’s their reaction to your findings so far?

Many of them are very frustrated that these issues have not been taken seriously, and definitely a lot of people are worried that they have been told that what you have is what you get, and this is not dangerous. Now, we know that it’s dangerous.

Have you heard from anybody who is doing this work that this phenomenon might actually dissuade people from joining ocean-going security forces?

No. And people take pride in what they’re doing. When you’re on a rescue mission, you do what it takes, and sometimes you put your own safety in the back seat. But one reason that these problems have not been taken seriously by higher echelons in many agencies around the world is that the operators don’t report their injuries. Why? This is called dissimulation. It’s known about fighter aircraft pilots, as well. The job you’re doing is so rewarding that you don’t want to quit. And when you’re told that you have to endure a little bit of pain, people do, and they get used to the pain. And they don’t go to the doctor on base, but they seek medical care outside the military.

Are you hopeful then that what your study is revealing will make it undeniable to these people that they are impacted by their work?

Well, that is already beyond discussion. Now, people know that this is dangerous. Now, we just have to find out what is dangerous so that they can do the job as efficiently as possible and make informed decisions when they choose how hard to push the boats through the waves.