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...

2022 (Q2) DOD Worldwide Numbers for TBI

Report
11/9/2022

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 second 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 | TBI Educators | TBICoE Research | Armed Forces Health Surveillance Division

2000-2022 Q2 DOD Worldwide Numbers for TBI

Report
11/9/2022

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 second 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 | TBI Provider Resources | TBI Educators | TBICoE Research | Armed Forces Health Surveillance Division

2021 DOD Worldwide Numbers for TBI

Report
11/9/2022

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

2022 (Q1) DOD Worldwide Numbers for TBI

Report
8/24/2022

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 first quarter of calendar year 2022.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBICoE Research | TBI Educators

2000-2022 (Q1) DOD Worldwide Numbers for TBI

Report
8/24/2022

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 first quarter of 2022. The data is also broken down by each branch of the armed services.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBICoE Research | TBI Educators

Longitudinal Study on Traumatic Brain Injury Incurred by Members of the Armed Forces in OIF/OEF

Report
5/4/2021

HR 5122 NDAA Conference Report for FY 2007 Sec. 721

Recommended Content:

Traumatic Brain Injury Center of Excellence

DCOE Annual Report 2014

Report
7/16/2015

Annual Report for the Defense Center of Excellence - 2014

Recommended Content:

Traumatic Brain Injury Center of Excellence | | Traumatic Brain Injury Center of Excellence | Posttraumatic Stress Disorder | Suicide Prevention | Department of Defense/Veterans Affairs Program Office | Health Readiness Support

Management of Traumatic Brain Injury in Tactical Combat Casualty Care

Report
7/26/2012

Defense Health Board: Management of Traumatic Brain Injury in Tactical Combat Casualty Care

Recommended Content:

Health Readiness Support | | Traumatic Brain Injury Center of Excellence

Indications and Conditions for In-Theater Post-Injury Neurocognitive Assessment Tool (NCAT) Testing

Report
5/31/2011

In accordance with Section 1673 of the NDAA HR 4986, signed into law in January of 2008, the Secretary of Defense was instructed to establish a protocol for the pre-deployment assessment and documentation of the cognitive functioning of Service Members deployed outside the United States.

Recommended Content:

Public Health | Health Readiness & Combat Support | Traumatic Brain Injury Center of Excellence | Disability Evaluation

Traumatic Brain Injury A Guide for Caregivers of Service Members and Veterans Module 3

Report
4/1/2010

Defense Health Board: Traumatic Brain Injury A Guide for Caregivers of Service Members and Veterans Module 3

Recommended Content:

Health Readiness Support | Traumatic Brain Injury Center of Excellence

Traumatic Brain Injury A Guide for Caregivers of Service Members and Veterans Module 1

Report
4/1/2010

Defense Health Board: Traumatic Brain Injury A Guide for Caregivers of Service Members and Veterans Module 1

Recommended Content:

Health Readiness Support | Traumatic Brain Injury Center of Excellence

A Guide for Caregivers of Service Members and Veterans Caregivers Companion

Report
4/1/2010

Defense Health Board: A Guide for Caregivers of Service Members and Veterans Caregivers Companion

Recommended Content:

Traumatic Brain Injury Center of Excellence

Traumatic Brain Injury A Guide for Caregivers of Service Members and Veterans Module 4

Report
4/1/2010

Defense Health Board: Traumatic Brain Injury A Guide for Caregivers of Service Members and Veterans Module 4

Recommended Content:

Health Readiness Support | Traumatic Brain Injury Center of Excellence

Traumatic Brain Injury A Guide for Caregivers of Service Members and Veterans Welome

Report
4/1/2010

Defense Health Board: Traumatic Brain Injury A Guide for Caregivers of Service Members and Veterans Welcome

Recommended Content:

Health Readiness Support | Traumatic Brain Injury Center of Excellence

Traumatic Brain Injury A Guide for Caregivers of Service Members and Veterans Module 2

Report
4/1/2010

Defense Health Board: Traumatic Brain Injury A Guide for Caregivers of Service Members and Veterans Module 2

Recommended Content:

Health Readiness Support | Traumatic Brain Injury Center of Excellence
Showing results 1 - 15 Page 1 of 1
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