Skip to main content

Military Health System

Important Notice about Pharmacy Operations

Change Healthcare Cyberattack Impact on MHS Pharmacy Operations. Read the statement to learn more. 

DOD warfighter brain health draft plan has six priorities

Image of Military medical personnel looking at a patient's brain scan. Lorie Falaminiano, an MRI technologist at Naval Medical Center San Diego, conducts a scan of a patient's brain Aug. 3. Brain scans that occur on a more frequent basis during a warfighter’s military career and beyond are one of the six concerns and priorities outlined by operational service members. (Photo by Navy Mass Communication Specialist Seaman Luke Cunningham.)

Documenting how warfighters score on cognitive testing – from the beginning of their careers until after they leave military service – is one of six major concerns and priorities of service members being addressed in a plan for brain health that is in final draft form.

This change to looking at brain exposures and traumatic brain injury (TBI) across the warfighter’s entire career represents a “paradigm shift” in the Department of Defense’s approach, TBI specialist Kathy Lee told the Society of Trauma Nurses annual conference, held virtually March 26.

Lee, senior health policy analyst for DOD’s Health Affairs, discussed the comprehensive strategy and plan for warfighter brain health (WBH), which addresses brain health, brain exposures, including blast exposures, TBI, and long-term and late effects of exposures and/or TBI.

General physical and brain health assessments, scans, or tests “that occur on a more frequent basis over time across their military careers and beyond if deficits are identified” is one of the six concerns and priorities outlined by operational service members, according to Lee.

Dissemination of information on which “brain exposures are most damaging” and “outright disclosure if they are at increased risk of exposure or injury while performing a specific training activity” such as breaching walls or experiencing blast overpressure is another priority and concern for transparency.

There are “multiple, deleterious effects of exposures before traumatic brain injury actually occurs” as well as TBI itself, Lee said. Known and emerging brain exposures are: blast overpressure; blunt force/impact; projectiles; directed energy (high-powered microwave); chemical-biological toxins; and other environmental hazards, she explained.

Patient being prepped for a PET scan Michelle Pribble, Naval Medical Center San Diego's lead nuclear medicine technologist, prepares a patient for a positron emission tomography (PET) scan in the hospital's Nuclear Medicine Department Oct. 6. A PET scan is used for revealing or evaluating conditions including brain disorders. (Photo by Navy Mass Communication Specialist Seaman Luke Cunningham.)

“Upwards of 86 percent of traumatic brain injuries are classified as mild” and are known as concussions, she said. “We can see 14,000 to 17,000 patient visits per month for TBI in the military health system, which is why we need standardized tools and research” to identify, control, and mitigate these brain exposures and TBIs.

The other four concerns expressed by service members are:

  • “Perceived disconnect” between operational efforts in preparation and training for combat and “medical communities translating brain health information to the service member in time to help them,” Lee said.
  • “Warrior mindset” that can discredit a service member’s own struggles or concerns “because they have a desire to complete their mission despite brain exposures, injury or illness” and “because they often compare themselves to other service members who may be in worse condition,” she said.
  • “Multiple concerns” over the newer emphasis on blast overpressure exposures and brain health and how safety and training changes may dilute training opportunities, deployment readiness and force lethality.
  • “Clinical tools, protocols, and research solutions” if the service member has been in the military longer and “may be noticing changes in functional abilities.”

All service members are required to take the Automated Neuropsychological Assessment Metrics test (ANAM) prior to deployment. The test has been in use since 2008 and has 10 domains to set up a baseline of cognition, which is one marker of brain health, Lee said.

“In fiscal 2019, we completed more than 220,000 of these assessments,” she said. “The WBH proposed plan will expand that requirement to include conducting the ANAM on all service members so that we can monitor and optimize cognitive performance and maximize combat effectiveness,” she said.

The WBH draft plan has 18 objectives and 53 associated activities along five “lines of effort” for “the deliberate, prioritized, and rapid development of end-to-end solutions,” Lee explained.

The five lines of effort are:

  • Optimize cognitive and physical performance
  • Identify, monitor, and mitigate brain exposures
  • Prevent, recognize, and minimize the effect of TBI
  • Reduce or eliminate long-term/late effects
  • Advance warfighter brain health science

The research and science objectives of the DOD plan are to “align brain health research and acquisition to current and emerging threats and operational requirements;” “maximize WBH research opportunities for partnerships with other government agencies, industry, and academia;” “enable researchers to have access to valid data regarding brain exposures and injuries and related brain health effects;” and “translate research findings into knowledge and materiel products, practice, and policies to maintain and optimize WBH,” Lee said.

Some of the research involves evaluating the late effects following blast and multiple TBIs by examining the brains of more than 200 service members from a repository at the Uniformed Services University of Health Sciences in Bethesda, Maryland, Lee noted.

Research includes examinations of clinical diagnoses, blood-based biomarkers, genetics, diagnostic imaging, and outcomes after treatment. A new rapid blood biomarker for TBI was cleared recently by the Food and Drug Administration for use in austere environments, adding to the armamentarium of biomarker tests.

The WBH plan is based on an Oct. 1, 2018, directive from DOD stating there should be a “single approach to brain health” in warfighters of all services that goes from brain exposure to TBI.

“Prior to this directive, there have been successful but disparate efforts,” Lee said.

The plan has been created through 18 months of field work and working groups, she noted. It is anticipated that the plan will be approved prior to the end of the fiscal year.

Her presentation was the first time the Society of Trauma Nurses had heard about the DOD plan, said society President Maria McMahon. It was noteworthy for practitioners because the DOD Warfighter Brain Health construct lends itself to nurse practitioner engagement in clinical practice, patient education, policy development, and emerging research.

Lee previously presented the data at December’s annual meeting of AMSUS, The Society of Federal Health Professionals, and the draft plan was part of a November 2020 themed issue of the Journal of the American Association of Nurse Practitioners.

You also may be interested in...

Fact Sheet
Jul 18, 2023

Low-Level Blast: Fact Sheet for Providers

.PDF | 1.26 MB

Low-level blast is defined as blast generated from firing heavy weapon systems or explosives in combat or training environments. Exposure to low-level blast does not typically result in a clinically diagnosable concussion, also known as mild traumatic brain injury. Both providers and service members should be aware of the potential effects of low ...

Video
Jul 13, 2023

Acute Concussion Care Pathway Overview

What is the Acute Concussion Care Pathway thumbnail of educational video for providers.

The Acute Concussion Care Pathway standardizes acute concussion care in the Military Health System. This video is designed to educate medical providers on the ACC Pathway, improving their understanding and application of evidence-based clinical tools. This video covers aspects of the ACC Pathway in detail, providing explanations and guidance on using ...

Infographic
Jul 12, 2023

What is the Acute Concussion Care Pathway?

What is the Acute Concussion Care Pathway? The Acute Concussion Care Pathway is one of the DHA Director’s Quadruple Aim Performance Plan projects. The intent is to equip providers with state-of-the-science tools to standardize concussion assessment and care across the MHS. It is supported by the DHA Procedural Instruction 6490.04 which establishes the infrastructure to ensure patients achieve optimal concussion clinical outcomes.

TBICoE developed this infographic as a quick reference tool that demonstrates application of the standardized acute concussion assessment and care process. By adhering to this established pathway of care for mild TBI, providers across the MHS can ensure a reduction in unwarranted variation and foster an integrated, standardized system of readiness and ...

Report
Jul 7, 2023

2022 Defense Intrepid Network Annual Report

.PDF | 11.07 MB

The NICoE 2022 Annual Report showcases the collective achievements and impact of the Defense Intrepid Network for TBI and Brain Health. This was a phenomenal year of growth in traumatic brain injury (TBI) clinical care, research, and education. In the report, you will learn about the expanded clinical offerings, advanced understanding of TBI through ...

Publication
Jun 16, 2023

Neurodegenerative Diseases and Traumatic Brain Injury Information Paper

.PDF | 310.80 KB

The long term effects of TBI are unknown, but there is concern that there may be an association with neurodegenerative diseases years after the injury. The intention of this information paper is to summarize the available evidence for or against an association of TBI with three of the more common neurodegenerative diseases.

Fact Sheet
Jun 14, 2023

Leader Policy Guidance for Mild TBI/Concussion in the Deployed Setting Fact Sheet

.PDF | 723.27 KB

This document describes the line leader responsibilities for the Department of Defense mandated policy, DOD Instruction 6490.11, “DOD Policy Guidance for the Management of Mild Traumatic Brain Injury/Concussion in the Deployed Setting,” that applies to all service members involved in potentially concussive events in deployed settings.

Report
Jun 12, 2023

2021 DOD Worldwide Numbers for TBI

.PDF | 847.35 KB

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.

Infographic
May 22, 2023

Dizziness and Visual Problems After Concussion

Graphic containing general information on dizziness and vision  problems after a traumatic brain injury. Visit health.mil/TBIFactSheets and download related fact sheets for information.

More than 80% of all concussions—also known as 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

Fact Sheet
May 22, 2023

Changes in Behavior, Personality or Mood Following Concussion/mTBI Fact Sheet

.PDF | 977.73 KB

This TBICoE fact sheet can be used by health care providers to educate patients with a concussion, or mild TBI, on how to manage changes in mood related to their injury. Patients and caregivers would also find this information useful.

Article
Apr 17, 2023

Concussion Protocols Aid Diagnosis, Treatment, and Recovery

Concussion Protocols Aid Diagnosis, Treatment, and Recovery

Whether on the sport field or the battlefield, the Defense Health Agency is the global leader in research on the effects of concussion—known as mild traumatic brain injury—in the military. Its research has fueled the development of protocols to help providers assess and treat concussion from initial injury to acute and post-acute medical settings, ...

Publication
Apr 7, 2023

2022 TBICoE Publication Catalog

.PDF | 577.80 KB

TBICoE publication citations and summaries are organized by category, or overarching research topic. The purpose of this document is to (1) summarize key findings and potential clinical implications of calendar year 2022 TBICoE publications, (2) increase awareness, and (3) assist in planning of future efforts.

Last Updated: January 22, 2024
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on X Follow us on YouTube Sign up on GovDelivery