Skip to main content

Military Health System

DOD warfighter brain health draft plan has six priorities

Image of Military medical personnel looking at a patient's brain scan. Military medical personnel looking at a patient's brain scan

Recommended Content:

Traumatic Brain Injury Center of Excellence | Brain Injury Awareness

Documenting how warfighters score on cognitive testing – from the beginning of their careers until after they leave military service – is one of six major concerns and priorities of service members being addressed in a plan for brain health that is in final draft form.

This change to looking at brain exposures and traumatic brain injury (TBI) across the warfighter’s entire career represents a “paradigm shift” in the Department of Defense’s approach, TBI specialist Kathy Lee told the Society of Trauma Nurses annual conference, held virtually March 26.

Lee, senior health policy analyst for DOD’s Health Affairs, discussed the comprehensive strategy and plan for warfighter brain health (WBH), which addresses brain health, brain exposures, including blast exposures, TBI, and long-term and late effects of exposures and/or TBI.

General physical and brain health assessments, scans, or tests “that occur on a more frequent basis over time across their military careers and beyond if deficits are identified” is one of the six concerns and priorities outlined by operational service members, according to Lee.

Dissemination of information on which “brain exposures are most damaging” and “outright disclosure if they are at increased risk of exposure or injury while performing a specific training activity” such as breaching walls or experiencing blast overpressure is another priority and concern for transparency.

There are “multiple, deleterious effects of exposures before traumatic brain injury actually occurs” as well as TBI itself, Lee said. Known and emerging brain exposures are: blast overpressure; blunt force/impact; projectiles; directed energy (high-powered microwave); chemical-biological toxins; and other environmental hazards, she explained.

Patient being prepped for a PET scan
Michelle Pribble, Naval Medical Center San Diego's lead nuclear medicine technologist, prepares a patient for a positron emission tomography (PET) scan in the hospital's Nuclear Medicine Department Oct. 6. A PET scan is used for revealing or evaluating conditions including brain disorders. (Photo by Navy Mass Communication Specialist Seaman Luke Cunningham.)

“Upwards of 86 percent of traumatic brain injuries are classified as mild” and are known as concussions, she said. “We can see 14,000 to 17,000 patient visits per month for TBI in the military health system, which is why we need standardized tools and research” to identify, control, and mitigate these brain exposures and TBIs.

The other four concerns expressed by service members are:

  • “Perceived disconnect” between operational efforts in preparation and training for combat and “medical communities translating brain health information to the service member in time to help them,” Lee said.
  • “Warrior mindset” that can discredit a service member’s own struggles or concerns “because they have a desire to complete their mission despite brain exposures, injury or illness” and “because they often compare themselves to other service members who may be in worse condition,” she said.
  • “Multiple concerns” over the newer emphasis on blast overpressure exposures and brain health and how safety and training changes may dilute training opportunities, deployment readiness and force lethality.
  • “Clinical tools, protocols, and research solutions” if the service member has been in the military longer and “may be noticing changes in functional abilities.”

All service members are required to take the Automated Neuropsychological Assessment Metrics test (ANAM) prior to deployment. The test has been in use since 2008 and has 10 domains to set up a baseline of cognition, which is one marker of brain health, Lee said.

“In fiscal 2019, we completed more than 220,000 of these assessments,” she said. “The WBH proposed plan will expand that requirement to include conducting the ANAM on all service members so that we can monitor and optimize cognitive performance and maximize combat effectiveness,” she said.

The WBH draft plan has 18 objectives and 53 associated activities along five “lines of effort” for “the deliberate, prioritized, and rapid development of end-to-end solutions,” Lee explained.

The five lines of effort are:

  • Optimize cognitive and physical performance
  • Identify, monitor, and mitigate brain exposures
  • Prevent, recognize, and minimize the effect of TBI
  • Reduce or eliminate long-term/late effects
  • Advance warfighter brain health science

The research and science objectives of the DOD plan are to “align brain health research and acquisition to current and emerging threats and operational requirements;” “maximize WBH research opportunities for partnerships with other government agencies, industry, and academia;” “enable researchers to have access to valid data regarding brain exposures and injuries and related brain health effects;” and “translate research findings into knowledge and materiel products, practice, and policies to maintain and optimize WBH,” Lee said.

Some of the research involves evaluating the late effects following blast and multiple TBIs by examining the brains of more than 200 service members from a repository at the Uniformed Services University of Health Sciences in Bethesda, Maryland, Lee noted.

Research includes examinations of clinical diagnoses, blood-based biomarkers, genetics, diagnostic imaging, and outcomes after treatment. A new rapid blood biomarker for TBI was cleared recently by the Food and Drug Administration for use in austere environments, adding to the armamentarium of biomarker tests.

The WBH plan is based on an Oct. 1, 2018, directive from DOD stating there should be a “single approach to brain health” in warfighters of all services that goes from brain exposure to TBI.

“Prior to this directive, there have been successful but disparate efforts,” Lee said.

The plan has been created through 18 months of field work and working groups, she noted. It is anticipated that the plan will be approved prior to the end of the fiscal year.

Her presentation was the first time the Society of Trauma Nurses had heard about the DOD plan, said society President Maria McMahon. It was noteworthy for practitioners because the DOD Warfighter Brain Health construct lends itself to nurse practitioner engagement in clinical practice, patient education, policy development, and emerging research.

Lee previously presented the data at December’s annual meeting of AMSUS, The Society of Federal Health Professionals, and the draft plan was part of a November 2020 themed issue of the Journal of the American Association of Nurse Practitioners.

You also may be interested in...

Be a Brain Warrior: Protect. Treat. Optimize.

Video
3/17/2023
Be a Brain Warrior: Protect. Treat. Optimize.

The Traumatic Brain Injury Center of Excellence is championing the theme 'Be a Brain Warrior: Protect, Treat, Optimize' during Brain Injury Awareness Month. The theme showcases the idea that service members, veterans, healthcare providers, caregivers, family members, and advocates can be warriors for brain health. Visit health.mil/BIAMonth to learn more.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Be a Brain Warrior: Protect. Treat. Optimize.

Sergeant Major of the Marine Corps: “Ask for Help” for TBI

Article
3/16/2023
Sergeant Major of the Marine Corps: “Ask for Help” for TBI

Concussions and TBIs are a significant health issue which affect service members and veterans during times of both peace and war. Between 2000-2023, there were a total of 468,424 first-time cases of TBI in the military worldwide, with just over 80% being considered mild TBI.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Be a Brain Warrior: Protect. Treat. Optimize.

Anomalous Health Incident (AHI) Acute Assessment Training

Publication
3/15/2023

This virtual training, hosted by the Traumatic Brain Injury Center of Excellence, will introduce MHS health care providers to Anomalous Health Incidents (AHI) and review assessment and treatment strategies. Detailed guidance on how to complete a medical evaluation using Anomalous Health Incident (AHI) Acute Assessment (DHA Form 244), will be provided.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Education & Training Events | TBI Provider Resources | TBI Educators

Chronic Traumatic Encephalopathy (CTE) Frequently Asked Questions

Fact Sheet
3/15/2023

This fact sheet provides answers and information to commonly asked questions about chronic traumatic encephalopathy, or CTE.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBICoE Research | TBI Provider Resources

INFORMATION PAPER: The Impact of Mild Traumatic Brain Injury on the Autonomic Nervous System

Publication
3/15/2023

The purpose of this information paper by TBICoE is to provide a general overview of the current evidence related to the impact of concussion/mild traumatic brain injury (mTBI) on the autonomic nervous system (ANS). This paper will focus on heart rate variability (HRV), pupillary light reflex (PLR), and hyperhidrosis within the military and civilian populations.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBICoE Research | TBI Provider Resources | TBICoE Podcasts

Driving After Traumatic Brain Injury at Womack Army Medical Center

Article Around MHS
3/8/2023
The Womack Army Medical Center uses a rehabilitation vehicle that builds confidence for a service member, diligently working to regain independence in their life after a traumatic brain injury. (Photo by Sameria Zavala, Womack Army Medical Center)

Traumatic brain injuries can end military careers and create great strains on military families. That's why the occupational therapists at Womack Army Medical Center have created a therapy that most of us take for granted to get injured soldiers back on the road to recovery.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Warrior Care | Be a Brain Warrior: Protect. Treat. Optimize.

2023 NICoE Brain Injury Awareness Month Events

Publication
2/28/2023

Downloadable PDF of the 2023 NICoE Brain Injury Awareness Month events they are hosting or participating in.

Recommended Content:

The National Intrepid Center of Excellence | Arts in Health Program | Brain Injury Awareness | Traumatic Brain Injury Center of Excellence | Be a Brain Warrior: Protect. Treat. Optimize.

Brain Injury Awareness with the 19th Sgt. Maj. of the Marine Corps

Video
2/21/2023
Thumbnail image of the Picking Your Brain podcast episode with Sgt. Maj. Troy Black

In this episode of Picking Your Brain, TBICoE Branch Chief, Capt. Scott Cota and clinical moderator Amanda Gano interview the 19th Sgt. Maj. of the Marine Corps, Sergeant Major Troy Black. The interview covers topics such as the DOD's Warfighter Brain Health Initiative, the commandant of the Marine Corps' Force Design 2030 efforts, and how warfighter brain health is a key factor in the human performance of Marines.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBICoE Podcasts | TBI Educators | TBI Provider Resources | Patient and Family Resources | Be a Brain Warrior: Protect. Treat. Optimize.

Optimizing Warfighter Brain Health and Performance

Video
2/21/2023
Thumbnail image of TBICoE's Dr. Sloley video.

Traumatic Brain Injury Center of Excellence research support cell chief, Dr. Stephanie Sloley, discusses her role in the organization and the importance of collaborative efforts in examining traumatic brain injuries. Dr. Sloley discusses the mission and vision of TBICoE and the importance of optimizing warfighter brain health and performance.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBICoE Research | Education & Training Events | TBI Educators | Be a Brain Warrior: Protect. Treat. Optimize.

What You Should Know About Concussions Fact Sheet

Fact Sheet
2/13/2023

This fact sheet is designed to educate deployed service members about traumatic brain injuries immediately after concussion injury.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Patient and Family Resources | TBI Educators | Be a Brain Warrior: Protect. Treat. Optimize.

2000-2022 Q3 DOD Worldwide Numbers for TBI

Report
2/8/2023

TBICoE is the Defense Department’s office of responsibility for tracking traumatic brain injury data in the U.S. military. Here you’ll find data on the number of active-duty service members—anywhere U.S. forces are located—with a first-time TBI diagnosis from calendar year 2000 through the third quarter of 2022. The data is also broken down by each branch of the armed services.

Recommended Content:

Traumatic Brain Injury Center of Excellence | DOD TBI Worldwide Numbers | Patient and Family Resources | TBI Educators

2022 Q3 DOD Worldwide Numbers for TBI

Report
2/8/2023

TBICoE is the Defense Department’s office of responsibility for tracking traumatic brain injury data in the U.S. military. Here you’ll find data on the number of active-duty service members—anywhere U.S. forces are located—with a first-time TBI diagnosis in the calendar year 2022 through the third quarter. The data is also broken down by each branch of the armed services.

Recommended Content:

Traumatic Brain Injury Center of Excellence | DOD TBI Worldwide Numbers | TBI Provider Resources | Patient and Family Resources | TBI Educators

2021 DOD Worldwide Numbers for TBI

Report
2/8/2023

TBICoE is the Defense Department’s office of responsibility for tracking traumatic brain injury data in the U.S. military. Here you’ll find data on the number of active-duty service members—anywhere U.S. forces are located—with a first-time TBI diagnosis in 2021. The data is also broken down by each branch of the armed services.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Educators | TBI Provider Resources | DOD TBI Worldwide Numbers

FEB 2023 TBICoE Quarterly Education Series Flyer

Publication
2/8/2023

TBICoE Quarterly Education Series: TBI Across the Lifespan. Join TBICoE at this virtual event to explore clinical best practices for prevention, assessment, and treatment of mild TBI, also known as concussion, for military dependents. Download the flyer for details.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Provider Resources | TBI Educators | Education & Training Events

Brain Injury Awareness Month: Hearing and Vision 4

Infographic
2/7/2023

DYK? If you sustain a head injury, you could also have vision, balance, and hearing damage problems. See your health care provider right away. https://vce.health.mil https://hearing.health.mil #BIAMonth #TBI

Recommended Content:

Brain Injury Awareness
<< < 1 2 3 4 5  ... > >> 
Showing results 1 - 15 Page 1 of 18
Refine your search
Last Updated: December 07, 2022
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on Twitter Follow us on YouTube Sign up on GovDelivery