Lance Cpl. Steven A. Meyer, an engineer with 3rd Combat Engineer Battalion, 1st Marine Division, takes the Automated Neuropsychological Assessment Metrics test at the Concussion Restoration Care Center at Camp Leatherneck, Afghanistan. The ANAM is a tool that tests neuro-cognitive skills such as reaction time that doctors can use to monitor the progress of concussed patients. The CRCC is the first clinic of its kind in Helmand province with a diverse medical staff capable of treating and rehabilitating service members with concussions.

The Brain and Concussion: Protect Your Strongest Weapon

By Capt. Jack Tsao, director, traumatic brain injury programs, U.S. Navy Bureau of Medicine and Surgery

Lance Cpl. Steven A. Meyer, an engineer with 3rd Combat Engineer Battalion, 1st Marine Division, takes the Automated Neuropsychological Assessment Metrics test at the Concussion Restoration Care Center at Camp Leatherneck, Afghanistan. The ANAM is a tool that tests neuro-cognitive skills such as reaction time that doctors can use to monitor the progress of concussed patients. The CRCC is the first clinic of its kind in Helmand province with a diverse medical staff capable of treating and rehabilitating service members with concussions.
Lance Cpl. Steven A. Meyer, an engineer with 3rd Combat Engineer Battalion, 1st Marine Division, takes the Automated Neuropsychological Assessment Metrics test at the Concussion Restoration Care Center at Camp Leatherneck, Afghanistan. The ANAM is a tool that tests neuro-cognitive skills such as reaction time that doctors can use to monitor the progress of concussed patients. The CRCC is the first clinic of its kind in Helmand province with a diverse medical staff capable of treating and rehabilitating service members with concussions. (Photo by Cpl. Kenneth Jasik/Released)

March is Brain Injury Awareness Month and therefore an opportunity to discuss the current state of traumatic brain injury (TBI) in the Navy. Let’s start with some TBI basics! Where do you think most Sailors and Marines sustain TBIs? If you guessed that the vast majority (approximately 84%) occur in the non-deployed setting and not as a direct cause of combat, you would be correct!  While the wars in Iraq and Afghanistan have made the term, “TBI,” commonplace, work and recreational activities at home remain the major sources of concussions in the military.

The most common type of TBI is mild TBI, also known as concussion.  It is estimated that nearly 80% of all active duty service member TBIs are concussions. Concussions occur due to a blow or jolt to the head, which results in an alteration of consciousness (change in the brains ability to think or process information). The most common causes of non-deployed TBI in service members include: motor vehicle collisions in privately owned vehicles, falls, sports, recreation activities, and military training.2  Given the active lifestyles, age associated high risk activities, and physical training requirements that are often typical for our service members, they actually sustain more concussions during work and leisure activities in much higher numbers than from combat.

You might be asking yourself, “What is the Navy doing to address mild TBI?”  The Navy, and military medicine in general, have taken an approach that focuses on prevention, education and training, early identification and treatment, and tracking of those service members who sustain a TBI.

Prevention is important and is demonstrated in the following ways: required head protection use on the job, when applicable (like Sailors on a flight deck wearing cranials); safety briefs which identify risky activities and ways to avoid it; and awareness of the need to seek medical evaluation, which ensures proper treatment and may prevent further complications. 

Education and training are key parts of the Navy plan because they help ensure all service members and leaders are aware of the signs and symptoms of TBI, and that they know how to respond when a mild TBI is suspected. Ideally, this means early referral to the military medical system. Navy Medicine’s required TBI training can be found on Navy Knowledge Online (NKO) and Navy e-learning.  Early identification and treatment are used to quickly treat service members once they are in the medical system. The Navy uses policy and clinical algorithms to ensure this requirement is met.  The algorithms and additional medical resources on TBI can be found at www.DVBIC.org.

Lastly, the Navy is making sure that service members are treated properly until symptoms resolve.  All of these efforts are done in partnership with our sister Services, the Defense and Veterans Brain Injury Center (DVBIC), and the Veterans Administration (VA)

How does the Navy approach compare to the civilian sector?  The military is working in collaboration with groups like the National Football League (NFL) and the Centers for Disease Control and Prevention (CDC) to raise awareness about and find the best treatments for concussion.  Lessons learned are shared whenever possible. In some states, such as Virginia, policies are in place at the high school level that are similar to the military policies.  These policies require pre-season training for athletes, parents, and teachers in the same way the military requires pre-deployment training for service members, leaders, and medical staff. 

The CDC and the NFL are also partnering with the military to further advance concussion awareness.  A great example is the “Heads Up” campaign that the CDC has run to help teach coaches and parents about concussion. The NFL has implemented guidance to protect players from recurrent concussions. The NFLs approach to concussion has even trickled down to the entertainment industry. For example, EA sports incorporates commentary on concussion in Madden Football. 

So what does this mean for you? It means that the military is working hard to advance the science behind identifying and treating concussion. We are partnering with civilian medical organizations, sharing information with youth and professional sports, and developing tools to protect and diagnose Service members on the battlefield and at the point of injury. 

3rd Battalion, 3rd Marines Battalion Aid Station- Hospital Corpsman 1st Class (FMF) Eugelio Gutierrez (IDC) (left) and Lt. Eusebio Flores, PA-C, MPAS (Assistant Bn Surgeon) (right) render care to injured Marine who ran face-first into a tree trunk sustaining facial and minor head injury during military training at Pōhakuloa Training Area (PTA) in Hawaii. (Courtesy photo)
3rd Battalion, 3rd Marines Battalion Aid Station- Hospital Corpsman 1st Class (FMF) Eugelio Gutierrez (IDC) (left) and Lt. Eusebio Flores, PA-C, MPAS (Assistant Bn Surgeon) (right) render care to injured Marine who ran face-first into a tree trunk sustaining facial and minor head injury during military training at Pōhakuloa Training Area (PTA) in Hawaii. (Courtesy photo)

Are you interested in more information on mild TBI?  www.dvbic.org has information on many aspects of TBI.  Training for Sailors can be found on NKO.  www.brainline.org/military has interactive and up-to-date information suitable for all audiences.  Even though Brain Injury Awareness Month is coming to an end, our efforts at prevention, early intervention, and effective treatment will continue.  

References:

  1. Defense and Veterans Brain Injury Center (DVBIC), DoD Worldwide Numbers of TBI, 2012.  Obtained March 21, 2013:  http://www.dvbic.org/dod-worldwide-numbers-tbi
  2. Defense and Veterans Brain Injury Center (DVBIC), DoD Worldwide Numbers of TBI, 2012.  Obtained March 21, 2013:  http://www.dvbic.org/dod-worldwide-numbers-tbi