WASHINGTON, DC—New in-theater clinical practice guidelines to catch Traumatic Brain Injury early will soon be instituted. “The real push this year—2010—is for early detection,” said Katherine Helmick, interim senior executive director for TBI at the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury.

TBI is the result of a blow or jolt to the head or a penetrating head injury that disrupts the function of the brain. Because those who sustain a mild TBI (mTBI) may not have obvious symptoms, they may not seek immediate medical attention. “You can have the event, and you may or may not seek medical care for that, depending on your subjective complaints,” said Helmick, who spoke at the 2010 MHS Conference.

While TBI screening procedures are already in place at various points of care throughout DoD and VA, it is important that these injuries are caught as early as possible. “We know that the possible effects of mTBI can include poor marksmanship, slower reaction time, and decreased concentration,” she said.

In order to make sure that there is early detection of TBI, new DoD guidelines will outline scenarios in which mandatory medical screening for TBI must be conducted in theater. Those scenarios include anyone who has been in a vehicle that was damaged by a blast, anyone within 50 meters of a blast, anyone within a structure hit by an explosive device, anyone who sustained a direct blow to the head or experienced a loss of consciousness, and anyone who is directed to be screened by their command.

A medic or corpsman using the Military Acute Concussion Evaluation (MACE) will evaluate a servicemember meeting the screening requirements. Helmick said that multiple versions of the MACE would be deployed because some servicemembers were found to have memorized the answers in advance.

Anyone who is evaluated must wait 24 hours and be re-evaluated prior to resuming duties. If a servicemember lost consciousness during the event, then a neurological evaluation must be conducted by a physician, physician assistant or nurse practitioner.

Expanding Resources and TBI Research

Physicians in theater who have questions regarding TBI can access the Defense and Veterans Brain Injury Center Virtual TBI Clinic. The virtual clinic provides TBI screening, assessment, consultation, and care to patients at remote military medical centers and troop intensive sites where demand for specialized care fluctuates with mass mobilizations. In addition, a deployed provider in theater who has a TBI question regarding a patient can e-mail TBI.consult@us.army.mil. “This is a deployed provider service only,” said Helmick.

The way forward for DoD in TBI research is to fast-track medical research projects in order to translate the findings to servicemembers in the field, according to Helmick. “We have got the signal from top leadership that we need to translate this money, translate these research/findings, into real live action on the battlefield, and we fully intend to do that,” she said.

Helmick said that DoD will also launch a comprehensive TBI prevention campaign to educate servicemembers. “Right now what we have is the enforcement by the command of personal protective equipment, and making sure those helmets are worn and that eyewear is worn. However, there is much else that we can do in looking at trying to increase the awareness of TBI and making sure that the word gets out to try to prevent these types of injuries,” she said.

Helmick emphasized the importance of accurately tracking concussions in patients by DoD, in part because of the concern about the long-term effects of cumulative and repeated concussions. A study commissioned by the NFL and carried out by the University of Michigan Institute of Social Research found that memory-related diseases are diagnosed at a rate of 19 times the normal rate for men ages 30 through 49. “We know that this is something to take seriously,” she emphasized. Being able to track the number of concussions will be extremely important to the understanding of long term effects.

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