Skip to main content

Military Health System

Test of Sitewide Banner

This is a test of the sitewide banner capability. In the case of an emergency, site visitors would be able to visit the news page for addition information.

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)

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...

Intrepid Spirit Centers promote healing from traumatic brain injury

Military health personnel in physical therapy

Intrepid Spirit Centers help heal TBI service members’ brains with interdisciplinary program and model of care.

Visual dysfunctions common in even mild TBI patients

Military health personnel examining a picture of an eye

Vision Center of Excellence ocular medical specialists discuss visual dysfunctions resulting from TBI.

TBI Hot Topics Bulletin March 2021


Are you a busy health care provider? Not enough time to keep up with the latest TBI research trends and news? Stay informed with the TBI Hot Topics Bulletin. TBICoE tracks the latest TBI scientific studies, advances, and discoveries most relevant to health care providers. This issue covers the fourth quarter of calendar year 2020.

Balancing rest, activity key to recovering from concussion

Two football teams facing off in the middle of a play

A newly revised suite of tools and resources for military health care providers will help improve the treatment of service members with concussions, and ensure their safe return to full duty.

Ask the Doc: Hit Head Hiking

U.S. Marines with The Basic School, Headquarter and Service Battalion, hike Old Rag Mountain at the Shenandoah National Park, Madison County, Va., Nov. 7, 2018. The motivational hike was held in honor of the Marine Corps Birthday as well as Veterans’ Day. (U.S. Marine Corps photo by Lance Cpl. Quinn Hurt)

Dear Doc: I decided to take advantage of the beautiful weather last weekend and went out hiking with a few friends. As we were headed up a pretty steep incline, I fell and hit my head on a rock. It hurt pretty badly at the time, but being the “warrior” that I am, I brushed it off and we finished the hike. I haven’t been to a doctor yet, but now I'm having pretty painful headaches, and I’ve also been getting dizzy and nauseous. Did I have a concussion and, if so, what should I do next? — Hit Head Hiking

Military researchers gain new insights into brain injuries

Military personnel sitting at a table collecting data

Blast injury research helps to fill knowledge gaps about brain injury.

Army Announces FDA Clearance of Field Deployable TBI Blood Test

Military personnel standing in the snow preparing to fire a missile

The US Army announced Food & Drug Administration clearance of a field-deployable traumatic brain injury blood test.

HEADS: Protect Your Strongest Weapon


This flyer promotes awareness of the key symptoms of concussion/mild TBI.

Distinguishing between TBIs, psychological conditions key to treatment

Military personnel holding a gun

Expert says long-lasting symptoms may be a sign of another issue.

Traumatic Brain Injury Awareness

Traumatic Brain Injury Awareness

A TBI is a blow or jolt to the brain that can be life-altering if the symptoms are not recognized. If you or a loved one experience the symptoms mentioned in this video, speak to a health care professional for more information.

New NICoE director sets an ambitious agenda for the future

Military personnel wearing face mask while talking to each other

The accomplished new leader of the NICoE and Intrepid Spirit Center network has plans for increased services and a higher profile for the unique care center.

Updated tools and training improve TBI and concussion recovery

A group of military personnel wearing face mask working on laptop computers

Up-to-date clinical tools help diagnose and manage TBI on and off the battlefield.

NICoE Brain Injury Awareness/March 2021Events


The National Intrepid Center of Excellence (NICoE) is hosting a number of virtual events throughout March 2021 in observance of Brain Injury Awareness Month.

March is Brain Injury Awareness Month; TBICoE’s mission lasts all year

Military health personnel performing a balance test on a patient

Staying a-head of TBI

TBICoE 2020 Publications


Master list of 2020 TBICoE Research Publications.

Page 8 of 18 , showing items 106 - 120
First < ... 6 7 8 9 10  ... > Last 
Refine your search
Last Updated: February 01, 2023
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on Twitter Follow us on YouTube Sign up on GovDelivery