Skip to main content

Military Health System

Immediate Testing: How the Military Evaluates Risk For Brain Injuries

Image of Pfc. Thomas Icenogle, a student in the Army’s Combat Medic Specialist Training Program at the Medical Education and Training Campus on Joint Base San Antonio-Fort Sam Houston, Texas, conducts a Military Acute Concussion Evaluation 2 (MACE 2) on Pvt. Alejandro Leija, while Pvt. Dominic Dubois refers to the MACE 2 card. (Photo: Lisa Braun, Medical Education and Training Campus Public Affairs). Pfc. Thomas Icenogle, a student in the Army’s Combat Medic Specialist Training Program at the Medical Education and Training Campus on Joint Base San Antonio-Fort Sam Houston, Texas, conducts a Military Acute Concussion Evaluation 2 (MACE 2) on Pvt. Alejandro Leija, while Pvt. Dominic Dubois refers to the MACE 2 card. (Photo: Lisa Braun, Medical Education and Training Campus Public Affairs)

Recommended Content:

Traumatic Brain Injury Center of Excellence

The United States military uses a standardized assessment tool to quickly evaluate for possible concussion. For any service member who is exposed to an explosion, a training accident or any other blow to the head, a key first step is to administer the Military Acute Concussion Evaluation 2, known as MACE 2. 

The MACE 2 is outlined on a portable pocket card to identify symptoms of a mild traumatic brain injury at the point of care. TBI symptoms can include headache, dizziness, and problems with sleep, vision or balance. 

“MACE 2 provides a common language and baseline criteria,” Stephanie Maxfield Panker, chief, research support cell with the Traumatic Brain Injury Center of Excellence said. 

TBI Testing: What is MACE 2? 

The military medical community began using MACE in 2006. An updated, six-part MACE 2, was developed in 2018 by adding relevant history questions and a screening for visual and dizziness related symptoms.  

“The changes improved the standard of care for patients by reducing the risks of overlooking patients with those problems,” Gary McKinney, a certified brain injury specialist and TBICoE chief of clinical practice and clinical recommendations, said. 

The MACE 2 provides detailed concussion screening, a cognitive test, a neurological exam, symptom specific questions and screening, and a history section on concussion.  

How Does the MACE 2 Evaluation Work? 

The MACE 2 assessment starts with monitoring for key or urgent signs of concern: 

  • worsening level of consciousness 
  • double vision or loss of vison 
  • restlessness, combative or agitated behavior 
  • repeated vomiting
  • seizures 
  • weakness or tingling in the arms or legs 
  • severe or worsening headache 

If the assessment identifies any of those red flags, the patient requires an immediate referral to a higher level of care. In a combat zone, that might warrant an urgent medical evacuation, McKinney said. 

If there are no red flags, the provider will ask questions about the event that caused the injury to determine if the patient has a changed level of consciousness or memory problems. The provider also asks for some medical history, such as whether the patient has had a concussion before, when, and how severe it was. 

The evaluator also conducts an initial mental function exam. For example, the provider might ask whether the patient knows where they are and can remember what happened right before the injury. 

A nervous system function exam is next. The evaluator will test a patient’s ability to speak coherently and to walk correctly. That’s followed by a test of the patient’s ability to concentrate and recall memories. Asking the patient to follow the evaluator’s finger movements can check for dizziness or eyesight problems. 

The initial MACE 2 score provides an assessment at that particular time. Future MACE 2 scores may help the provider understand how the patient’s symptoms are changing to determine if the patient’s mental status has improved or worsened over time. 

Concussion Testing on the Front Lines 

The joint services’ Medical Education and Training Campus at Joint Base San Antonio-Fort Sam Houston, Texas, trains combat medics, along with combat life savers, to recognize potential head injuries along with the signs and symptoms that would require a MACE 2 and further evaluation. 

“Combat medics are instrumental in identifying the possibility of a TBI based on mechanism of injury, signs and symptoms, assessing for severity, and administering the MACE 2 as soon as possible after evacuation from the point of injury,” Jeremy Clarno, METC’s Combat Medic Specialist Training Program field craft chief, said. “This is crucial because early detection and treatment are the keys to preventing long-term effects.” 

Evaluators typically perform MACE 2 evaluations at battalion-level aid stations or higher. 

You also may be interested in...

Brain Injury Awareness Month Banner

Infographic
2/17/2022
Brain Injury Awareness Month Banner

March is Brain Injury Awareness Month. Traumatic brain injuries are a key health concern for the military community. Thanks to innovations across the Military Health System, we are improving quality of life for TBI patients & their families. This month, we will share stories, tips, and resources for TBI prevention and recovery. www.health.mil/BIAMonth #BeTBIReady #BIAMonth

Recommended Content:

Brain Injury Awareness To Improve Readiness | Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence

BIAM Vision and Hearing

Infographic
2/17/2022
BIAM Vision and Hearing

Vision and hearing are vital senses for effective communication and situational awareness. To defend yourself against injury and maintain mission readiness, wear the proper vision and hearing protection while on and off duty. Find the latest vision and hearing protection recommendations here: • Vision: https://vce.health.mil/Eye-Injury-Prevention-and-Response/Eye-Protection • Hearing: https://hearing.health.mil/Prevention/Evaluated-Hearing-Protection-Devices #BIAMonth #BeTBIReady

Recommended Content:

Brain Injury Awareness To Improve Readiness | Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence | Vision and Hearing Loss Prevention

BIAM TBI 3

Infographic
2/17/2022
BIAM TBI 3

#DYK Symptoms of TBI aren’t just physical? Severe TBIs can increase the risk for mental health conditions, such as anxiety and depression. Learn more: https://www.health.mil/Military-Health-Topics/Centers-of-Excellence/Traumatic-Brain-Injury-Center-of-Excellence/Patient-and-Family-Resources #BeTBIReady

Recommended Content:

Brain Injury Awareness To Improve Readiness | Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence

Brain Injury Awareness Month 1

Infographic
2/17/2022
Brain Injury Awareness Month 1

Even a mild traumatic brain injury can impact mission readiness and the ability to deploy. #BeTBIReady by understanding the signs and symptoms of TBI, and knowing when to seek care. Thanks to innovations across the Military Health System, TBI is treatable & recovery is possible. www.Health.mil/BIAMonth #BIAMonth #BeTBIReady

Recommended Content:

Brain Injury Awareness To Improve Readiness | Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence

BIAM Head Injury

Infographic
2/17/2022
BIAM Head Injury

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 #BeTBIReady

Recommended Content:

Brain Injury Awareness To Improve Readiness | Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence

BIAM TBI 2

Infographic
2/17/2022
BIAM TBI 2

#DYK Most TBIs experienced by service members are mild concussions? But, remember, even a mild TBI can impact your overall health and ability to deploy. Learn more: https://www.health.mil/Military-Health-Topics/Centers-of-Excellence/Traumatic-Brain-Injury-Center-of-Excellence/Patient-and-Family-Resources #BeTBIReady

Recommended Content:

Brain Injury Awareness To Improve Readiness | Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence

BIAM TBI

Infographic
2/17/2022
BIAM TBI

#DYK Most TBIs don’t occur while deployed? TBIs typically result from activities like sports, falls, or car accidents. Wearing protective gear is one way you can minimize your risk of TBI. #BeTBIReady https://www.health.mil/tbi

Recommended Content:

Brain Injury Awareness To Improve Readiness | Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence

BIAM Providers

Infographic
2/17/2022
BIAM Providers

Providers: Stay up-to-date on the latest evidence-based clinical guidance and training so you are always #TBIReady. Visit: https://vce.health.mil/Clinicians-and-Researchers/Clinical-Practice-Recommendations, and https://hearing.health.mil/For-Providers. #BIAMonth #BeTBIReady

Recommended Content:

Brain Injury Awareness To Improve Readiness | Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence

BIAM Call to Action

Infographic
2/17/2022
BIAM Call to Action

#PSA! Don’t forget your protective gear! Most TBIs do not occur in combat. They are usually caused by everyday activities like sports, training, or a car accident. You can minimize the risk of TBI by wearing protective gear. www.health.mil/BIAMonth #BeTBIReady #BIAMonth

Recommended Content:

Brain Injury Awareness To Improve Readiness | Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence

BIAM Caregivers

Infographic
2/17/2022
BIAM Caregivers

#DYK? Family support helps TBI recovery? Learn how to support your loved one here: https://www.health.mil/News/Articles/2021/07/22/Caregiver-Guide-supports-service-members-and-veterans-with-TBI #BeTBIReady #BIAMonth

Recommended Content:

Brain Injury Awareness To Improve Readiness | Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence

Brain Injury Awareness Month 2

Infographic
2/17/2022
Brain Injury Awareness Month 2

TBI symptoms aren’t just physical. Research shows traumatic brain injuries can lead to sleeping problems. Ignoring these problems can worsen symptoms and lead to longer recovery times. Learn more: www.health.mil/TBIproviders #BeTBIReady #BIAMonth

Recommended Content:

Brain Injury Awareness To Improve Readiness | Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence

BIAM Main

Infographic
2/17/2022
BIAM Main

March is Brain Injury Awareness Month. Traumatic brain injuries are a key health concern for the military community. Thanks to innovations across the Military Health System, we are improving quality of life for TBI patients & their families. This month, we will share stories, tips, and resources for TBI prevention and recovery. www.health.mil/BIAMonth #BeTBIReady #BIAMonth

Recommended Content:

Brain Injury Awareness To Improve Readiness | Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence

TBI Prevention

Video
2/9/2022
TBI Prevention

It is important for everyone to remember that we only have one brain. That means taking the necessary to protect your brain when engaging in sports, driving, or during exercises while on-duty.

Recommended Content:

Traumatic Brain Injury Center of Excellence

Tackling Concussions: NCAA-DOD CARE Consortium Battles Brain Injuries

Article
1/6/2022
Naval Academy football team runs onto the field

Dr. Paul Pasquina and Dr. Terry Rauch recently discussed the NCAA-DOD Concussion Assessment, Research and Education (CARE) Consortium, the largest concussion and repetitive head impact study in history, on the NCAA’s “Social Series.”

Recommended Content:

Uniformed Services University of the Health Sciences | Traumatic Brain Injury Center of Excellence | Medical Research and Development | Injury Prevention

Dizziness and Visual Problems After Concussion

Infographic
1/4/2022
Dizziness and Visual Problems After Concussion

More than 80% of all concussions—also known as a mild traumatic brain injury— in the military are considered mild. Dizziness and visual problems are among the most common symptoms after concussion and often resolve within days or weeks. This infographic reviews common signs and symptoms to look out for.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence | Patient and Family Resources
<< < 1 2 3 4 5  ... > >> 
Showing results 31 - 45 Page 3 of 17
Refine your search
Last Updated: September 01, 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