Policy to Mandate Head Injury Evaluations

By Army Sgt. 1st Class Michael J. Carden
American Forces Press Service

March 10, 2010 - Defense Department officials expect to launch a new policy in the coming months that will make head-injury evaluations mandatory for all troops who suffer possible concussions, a senior official with the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury said. The current guidelines for treating troops with such injuries allows for them to come forward on their own. Troops in combat and in close contact with explosions or blasts make the decision on whether they need to be evaluated for concussions or head injuries.

But under the new policy, every servicemember exposed to such an incident will be required to seek attention. Those troops also will be required to rest and will be excluded from their unit's mission cycle for at least 24 hours, Kathy Helmick, the senior director for traumatic brain injury at the center, said yesterday in an interview with American Forces Press Service.

"What is getting ready to become policy is a paradigm shift from a servicemember coming forward and saying, 'I have a complaint' to an incident-based protocol," Helmick said. "When those events happen, you don't get to say, 'I'm having symptoms.' You go to medical, and you get checked out, regardless of whether you have symptoms or not."

Early detection and treatment is the cornerstone of the new policy, she said. The guidelines will help health care providers and researchers track such occurrences as well as expand their knowledge in treatment. The policy also will help to ensure unit readiness and longevity in the afflicted troops, Helmick noted.

The policy is intended to addresses the culture of troops who are so dedicated to their mission that they often shrug off their symptoms and simply learn to deal with them, she said. However, she added, failing to get treatment and education about their possible conditions may do more harm than good, not only for the troop in question but the unit as well.

Avoiding evaluations and treatment can be troublesome once the mission is complete and the servicemember returns home, Helmick said, because concussion indicators are not limited solely to concussions. They actually can be confused with symptoms troops may have in their readjustment period after a deployment.

"The premise here is that we know folks were so mission-focused that sometimes they weren't being evaluated," Helmick said. "If troops don't come forward and simply 'will it away' and carry on with their mission, by the time they get home, those symptoms could be confused with readjusting to life back home.

"This is really an effort to provide state-of-the-art, up-front care quickly to the time of injury," she continued. "If you had a sprained ankle, you wouldn't be hobbling around on your ankle for eight months before you received care."

Since 2006, servicemembers exposed to roadside bombs, sports injuries and other incidents that could result in head injuries have participated in the military acute concussion evaluation. The evaluation is done in theater and is flexible enough to be done while "bullets are flying," Helmick said.

Line medics and Navy corpsmen can give the evaluation on the spot or at the base camp in about 10 to 15 minutes without troops having to be transported to a field hospital. Studies have shown that troops recover quicker when they're close to their unit, she said.

Troops are asked a series of questions that help the medics determine the severity of the concussion. Afterward, the troop is required to rest for 24 hours, and then participate in a follow-up evaluation. If the symptoms persist, more evaluations will be done to determine if the troop needs to be evacuated to a larger medical facility. If not, the troop will get back in the fight.

"You can almost do the evaluation with bullets flying," she said. "It's not supposed to be done in a controlled environment, but will identify red flags, tell the medics about the symptoms and give a very gross overview of the servicemember's cognitive state."

Making the evaluation mandatory for all troops in question was a request from troops on the front lines, and has drawn much attention from senior defense officials here, Helmick said.

She noted that Navy Adm. Mike Mullen, chairman of the Joint Chiefs of Staff, has "really taken the stance" in not leaving the evaluation to subjective reporting by the individual servicemember. Leadership realizes the culture of mission focus and the demanding set of actions that servicemembers need to make, she said.

"If you lay it out for servicemembers, and they understand their conditions, you decrease the symptoms and you get better faster," she said. "If you don't detect it, you can't educate about it, [and] you lose that opportunity to provide an educational intervention.

"What we hope to do is save lives from the serious injuries and decrease chronic symptoms of having problems with concussions," she continued. "With policy change, we're going to treat quicker and return troops to duty faster in full capacity."

The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury was created in November 2007, and assesses, validates, oversees and facilitates prevention, resilience, identification, treatment, outreach, rehabilitation and reintegration for psychological health and brain injury for the Defense Department, military members and their families, according to its Web site.

The center also works closely with the Veterans Affairs Department to ensure veterans suffering from psychological health issues and traumatic brain injury receive the most up-to-date care.