1. Mild Traumatic Brain Injury/Concussion
Training Program for Service Members
Mild Traumatic Brain Injury/Concussion
“Medically Ready Force…Ready Medical Force”

2. “Medically Ready Force…Ready Medical Force”
Agenda
Identify how concussion/mild traumatic brain injury (mTBI) can affect Service members
Discuss how concussions impact mission readiness
Review essential 5 Points about TBI that service members must know to be mission ready
Review available resources related to concussion
“Medically Ready Force…Ready Medical Force”

3. “Medically Ready Force…Ready Medical Force”
5 Key Points about TBI
A concussion is a mild traumatic brain injury
Identify it early
Get checked out
Rest and recover
Return to duty
“Medically Ready Force…Ready Medical Force”

4. Point One: A Concussion is a Mild Traumatic Brain Injury (m/TBI)
Concussion is also known as a mild traumatic brain injury (mTBI)
Concussion:
Is caused by a blow or jolt to the head
Can occur even without being knocked out
Can change the way the brain works
Important to seek medical attention after a concussion, no matter how mild it may seem
“Medically Ready Force…Ready Medical Force”

5. Department of Defense Definition of Traumatic Brain Injury
TBI is a traumatically induced structural injury and/or physiological disruption of brain function as a result of an external force. TBI is indicated by new onset or worsening of at least one of the following clinical signs, immediately following the event:
Any period of loss of consciousness (LOC)
Any loss of memory for events immediately before or after the injury (PTA)
Any alteration in mental state at the time of the injury (AOC)
Neurological deficits that may or may not be transient (or permanent)
Intracranial lesion
“Medically Ready Force…Ready Medical Force”

6. “Medically Ready Force…Ready Medical Force”
Concussion Facts
A concussion can occur even without being knocked out/losing consciousness
A concussion can temporarily change the way the brain works
Common causes of concussion include:
Blow to the head
Vehicle crashes
Being near a blast
Early detection, appropriate treatment, and downtime are essential for successful recovery
The majority of concussions resolve with proper rest or treatment
“Medically Ready Force…Ready Medical Force”

7. Introduction: Knowledge Check
Which of the following is not a common cause of concussion?
Blow to the head
Vehicle crash
Falls
Dehydration
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8. “Medically Ready Force…Ready Medical Force”
TBI Classification
TBI is classified as
Mild, Moderate, Severe, or Penetrating
Classification describes the severity at the time of injury
It does not describe the resulting impairments or duration of symptoms
The majority of service members can expect a full recovery, even with multiple concussions
Early detection and treatment are essential
Recovery may take longer with recurrent concussions
“Medically Ready Force…Ready Medical Force”

9. “Medically Ready Force…Ready Medical Force”
Question 1:
Sergeant Spencer is delayed reporting to formation. Can you see any behaviors that may lead to a head injury?
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10. Question 1: Select Answer
Question: What behaviors shown in the previous image could lead to a head injury? Check all that apply.
Sergeant Spencer may feel rushed to get to formation on time and may not act in a careful manner.
Sergeant Spencer is still around heavy equipment and should be wearing protective head gear.
Sergeant Spencer’s buddy should get to formation on time.
The section leader could reprimand Sergeant Spencer for not following motor pool safety regulations.
“Medically Ready Force…Ready Medical Force”

11. “Medically Ready Force…Ready Medical Force”
Question 2
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12. Second Point One Knowledge Check Question
Question: In which situations should you have your helmet on? Note all that are correct.
When driving in a military vehicle.
When working in the motor pool.
When inside an U.S. military building, while unarmed.
When loading and offloading equipment in garrison.
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13. Third Point One Knowledge Check
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14. Third Point One Knowledge Check Question
Question: Is it ever safe to crawl around in a military vehicle without a helmet?
Yes No
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15. Point Two: Identify it early
Mandatory Events Requiring Evaluation
Per DoDI , exposure to the following events mandates prompt command and medical concussion evaluation, event reporting and a minimum 24-hour rest period
Anyone involved in a vehicle blast event, collision, or rollover
All within 50 meters of a blast (inside or outside)
Anyone who sustains a direct blow to the head or losses consciousness
Anyone exposed to more than one blast event (the Service member’s commander shall direct a medical evaluation)
“Medically Ready Force…Ready Medical Force”

16. First Point Two Knowledge Check
Question: Which of the following events does NOT mandate notification to command, a concussion evaluation, event reporting and a minimum 24 hour rest period?
Involvement in a vehicle crash, collision or a roll over
Being 20 meters nearby blast
sustaining a direct blow to the head or loss of consciousness
Tripping over a pair of boots
Being exposed to more then one blast event within 12 months
“Medically Ready Force…Ready Medical Force”

17. How to Identify a Concussion (2)
Service members are required to report involvement in a mandatory event using the I.E.D. and H.E.A.D.S. checklist
Can also be used to assess soldiers without apparent injury and who were not exposed to a mandatory event
Use three-step assessment process
1. Injury ( Yes or No)
Is there physical damage to SM body or body part?
“Medically Ready Force…Ready Medical Force”

18. How to Identify a Concussion
2. Evaluation: H.E.A.D.S (Yes/No)
H – Headache and/or vomiting
E – Ears ringing
A – Amnesia and/or Alteration of consciousness/Loss of Consciousness
D – Double vision and/or dizziness
S – Something feels wrong or is not right
“Medically Ready Force…Ready Medical Force”

19. How to Identify a Concussion (3)
3. Distance
Was SM within 50M of blast? (Y/N)
Record the distance from blast for ALL SM
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20. Second Point Two Knowledge Check
Sergeant Spencer hurts his head inside the vehicle when he went back into retrieve his items while not wearing his helmet.
“Medically Ready Force…Ready Medical Force”

21. Second Point Two Knowledge Check Question
Question: Sergeant Spencer believes that leadership will be annoyed if he goes to the clinic to get his head checked out or that he will be accused of malingering. Soon, Sergeant Spencer experiences sleep disturbances, headache and vision problems. What Should he do?
Sergeant Spencer is needed by his unit so it is best that he “tough it out” even though he does not feel well.
Sergeant Spencer’s symptoms will most likely pass after he has a good meal and a rest, so he should wait until the next day to see how he feels.
Sergeant Spencer should identify his concussion early by going to the clinic, so his symptoms do not become more pronounced.
If Sergeant Spencer is not feeling well, he is not performing well, thereby putting his entire unit at risk by not treating his concussion.
“Medically Ready Force…Ready Medical Force”

22. Second Point Two Knowledge Check Question (part b)
Question: What did Sergeant Spencer need to do to adhere to the TBI protocol for identifying concussion? Check all that apply.
Apply both the I.E.D and the HEADS checklist
Report to the clinic to get evaluated
Move away from the blast immediately
Sergeant Spencer does not report his injury when he reports to formation
“Medically Ready Force…Ready Medical Force”

23. Point Three: Get Checked Out
DoD Policy Guides Medical Treatment
Anyone involved in a potentially concussive event receives a mandatory medical evaluation
Anyone involved in a potentially concussive event receives a minimum mandatory 24 hour downtime even if the individual is not diagnosed with a concussion
Only medical staff can determine if a concussion occurred
“Medically Ready Force…Ready Medical Force”

24. First Point Three Knowledge Check
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25. First Point Three Knowledge Check Question
Question: What is the next step for Sergeant Spencer to properly care for his concussion, according to DoD policy guidelines?
Sergeant Spencer needs to report to the medical clinic to be examined by medical personal.
Sergeant Spencer needs to report the location of the incident to his commanding officer.
Sergeant Spencer needs to put an ice pack on his head.
Sergeant Spencer needs to be sure he experienced a concussive event before he reports to the medical clinic.
“Medically Ready Force…Ready Medical Force”

26. Point Four: Rest and Recovery
Impact of Multiple Concussions
Symptoms may be more severe with each additional concussion and they may take longer to resolve
Theater Medical Management requires a longer rest period after 2 concussions (minimum 7 days) and a more in-depth evaluation for those who have sustained 3 or more concussions in 12 months
Leaders need to take steps to prevent a second concussion during recovery
No combatives, sports, etc. until cleared by medical
“Medically Ready Force…Ready Medical Force”

27. Approaches to Recovery
Rest Helps Recovery
Exertion Hurts Recovery
Body
Keep heart rate low
Stay out of heat
Limit physical activity
Working
Heavy lifting
Alcohol use
Prevent another concussion
Mind
Allow downtime during the day
Allow adequate sleep at night
Intensive writing
Intensive concentration
Playing video games
Inadequate sleep
Caffeine
“Medically Ready Force…Ready Medical Force”

28. First Point Four Knowledge Check
Sergeant Spencer is diagnosed with a concussion/mTBI and instructed to follow a strict protocol of rest and recovery.
“Medically Ready Force…Ready Medical Force”

29. First Point Four Knowledge Check Question
Question: Which of the following will impact a patient’s recovery ? Check all that apply
The place where the TBI occurred.
The number of past TBIs the patient sustained.
Strict avoidance of behaviors that harm recovery.
Following proper rest protocols.
“Medically Ready Force…Ready Medical Force”

30. Point Five: Return to Duty
The medical provider will advise when it is safe to return to duty
The majority of symptoms resolve within hours to days
DoD policy requires return to duty testing similar to that used with professional athletes before medically clearing a Service member after a concussion
“Medically Ready Force…Ready Medical Force”

31. First Point Five Knowledge Check
Question: What are some of the behaviors that are being exhibited in the image below that might prohibit Sergeant Spencer’s recovery?
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32. First Point Five Knowledge Check Question
Check all that apply
Sergeant Spencer is using his electronic device to play video games.
Sergeant Spencer does not appear to have been eating in a healthy manner.
Sergeant Spencer is not avoiding over stimulating environments.
Sergeant Spencer is keeping his heart rate low.
“Medically Ready Force…Ready Medical Force”

33. Second Point Five Knowledge Check
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34. Second Point Five Knowledge Check Question
Question: What is a likely outcome for Sergeant Spencer in terms of his return to duty?
Sergeant Spencer will return to duty when he feels ready.
Sergeant Spencer will need to continue to follow the return to duty recovery advice of the medic.
Sergeant Spencer is ready to return to duty, despite still having symptoms.
Sergeant Spencer has few enough symptoms that he can return to duty within the week.
“Medically Ready Force…Ready Medical Force”

35. Deploying Service Members Key Points
Concussion is a disruption of brain function resulting from a blow or jolt to the head
DoD policy mandates anyone involved in a potentially concussive event receives a mandatory medical evaluation
Use IED checklist including ‘HEADS’ evaluation to help identify concussion
Service members involved in a potentially concussive events receive minimum of 24 hour downtime
The majority of symptoms will resolve with proper treatment
The medical provider will advise when it is safe for a Service member to return to duty
“Medically Ready Force…Ready Medical Force”

36. Free Additional DVBIC Resources
dvbic.dcoe.mil or
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37. “Medically Ready Force…Ready Medical Force”
Questions
TBI POCs: Medical Director: Rank, Name, (mobile phone/text) TBI Director: Name, (mobile phone/text)
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