WASHINGTON, DC—Line commanders will play a greater role in ensuring that servicemembers in theater who may have sustained a head injury get medical attention, a DoD official said at the 4th Annual TBI Military Training Conference held in August.

Kathy Helmick, an official with the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, noted that up to 25% of civilians who have suffered a concussion do not seek care for the condition. The military, she said, is doing its best to detect all concussions through various programs.

In order to better identify mTBIs in theater, DoD issued a new directive type memorandum (DTM) in June that calls on line commanders to share in the responsibility of ensuring that servicemembers who may have sustained a potential head injury seek medical attention, she told conference participants. “This Directive Type Memorandum dealing with battlefield care for mild TBI really creates a unique marriage between the line commanders and medical assets. This is really the first time in history in which the line commanders have a portion of responsibility to ensure that their charges get into the medical system for a mandatory evaluation.”

Ensuring Servicemembers Receive Medical Attention

The new guidelines replace ones established in 2007 that required injured service members to come forward with symptoms. Servicemembers are often reluctant to seek care in theater because they do not want to be pulled from their duties.

Helmick explained that rather than a servicemember being prompted to seek medical attention when they experience a symptom, particular events will now direct when a servicemember must receive a mandatory evaluation. “So these are mandatory event-driven protocols not symptom-driven protocols.”

Helmick told reporters that the directive now requires that a servicemember go for a mandatory medical evaluation when the servicemember is within certain perimeters of a blast. All sports and activities that carry a risk of concussion are prohibited until the servicemember is medically cleared.

The new DTM also provides new protocols for anyone sustaining three or more mTBIs within a 12-month period. “The new way of doing business is three concussions in 12 months and you get a comprehensive evaluation.”

Helmick also said that another new aspect to the DTM is that DoD will now closely track mTBI incidents. “If you are a commander and you have 14 guys in two MRAPs when the bomb goes off, all 14 of those guys have to be accounted for that they went to medical [and] that they were cleared or not.”

DoD hopes that through this system servicemembers will receive earlier treatment for a mild concussion that will lessen the possibility that they are exposed to further injury.

Helmick said that what is needed in the future is the implementation and enforcement of the DTM by all services. In addition, coordination between DoD agencies to analyze the mTBI data obtained from theater as a result of the DTM will also be important. “We also need to continue with full force to get validated objective measures and strategies to diagnose concussion on the battlefield,” she added.

Another issue that Helmick addressed is educating servicemembers on the importance of seeking care for a potential brain injury. DoD is partnering with the NFL to collaborate on efforts to break down the barriers that may prevent a servicemember from seeking help and getting treatment.

Research initiatives involving TBI also remain an important priority, including translating promising research into practice in an expedited fashion when a threshold of scientific rigor has been met to safely institute it, according to Helmick’s presentation. In addition, continuing to work with VA and other organizations to yield collaborations and products to improve TBI care will be an important element for DoD moving forward.

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