title: Acute clinical care and care coordination for traumatic brain injury within Department of Defense.
abstract: The nature of current combat situations that U.S. military forces encounter and the use of unconventional weaponry have dramatically increased service personnel's risks of sustaining a traumatic brain injury (TBI). Although the true incidence and prevalence of combat-related TBI are unknown, service personnel returning from deployment have reported rates of concussion between 10% and 20%. The Department of Defense has recently released statistics on TBI dating back to before the wars in Iraq and Afghanistan to better elucidate the impact and burden of TBI on America's warriors and veterans. Patients with severe TBI move through a well-established trauma system of care, beginning with triage of initial injury by first-responders in the war zone to acute care to rehabilitation and then returning home and to the community. Mild and moderate TBIs may pose different clinical challenges, especially when initially undetected or if treatment is delayed because more serious injuries are present. To ensure identification and prompt treatment of mild and moderate TBI, the U.S. Congress has mandated that military and Department of Veterans Affairs hospitals screen all service personnel returning from combat. Military health professionals must evaluate them for concussion and then treat the physical, emotional, and cognitive problems that may surface. A new approach to health management and care coordination is needed that will allow medical transitions between networks of care to become more centralized and allow for optimal recovery at all severity levels. This article summarizes the care systems available for the acute management of TBI from point of injury to stateside military treatment facilities. We describe TBI assessment, treatment, and overall coordination of care, including innovative clinical initiatives now used.
authors.affiliation: Defense and Veterans Brain Injury Center, Walter Reed Army Medical Center (WRAMC), Washington, DC, USA.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Jaffee
authors.forename: Kathy M
authors.initials: KM
authors.lastname: Helmick
authors.forename: Philip D
authors.initials: PD
authors.lastname: Girard
authors.forename: Kim S
authors.initials: KS
authors.lastname: Meyer
authors.forename: Kathy
authors.initials: K
authors.lastname: Dinegar
authors.forename: Karyn
authors.initials: K
authors.lastname: George
mesh_terms: D017732:Air Ambulances; D001753:Blast Injuries / Q000150:complications; D001930:Brain Injuries / Q000175:diagnosis* / Q000523:psychology / Q000534:rehabilitation*; D003266:Continuity of Patient Care; D003422:Critical Care; D006801:Humans; D008889:Military Personnel; D038223:Post-Concussion Syndrome / Q000523:psychology / Q000534:rehabilitation*; D012720:Severity of Illness Index; D014857:Warfare