Skip to main content

Military Health System

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)

Recommended Content:

Traumatic Brain Injury Center of Excellence

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...

Military Traumatic Brain Injury: The History, Impact, and Future

Video
3/23/2023
Military Traumatic Brain Injury: The History, Impact, and Future

Megan Lindberg, Pathway of Care Manager for the Traumatic Brain Injury Center of Excellence, gives a presentation on the history, impact, and future of TBI in the military during the National Museum of Health and Medicine's Science Cafe series, March 23, 2023. The museum's Science Cafe is a regular speaker series that explores topics within military medicine, connecting the mission of the Department of Defense museum with the public.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Be a Brain Warrior: Protect. Treat. Optimize.

Be a Brain Warrior: Protect. Treat. Optimize.

Video
3/17/2023
Be a Brain Warrior: Protect. Treat. Optimize.

The Traumatic Brain Injury Center of Excellence is championing the theme 'Be a Brain Warrior: Protect, Treat, Optimize' during Brain Injury Awareness Month. The theme showcases the idea that service members, veterans, healthcare providers, caregivers, family members, and advocates can be warriors for brain health. Visit health.mil/BIAMonth to learn more.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Be a Brain Warrior: Protect. Treat. Optimize.

Brain Injury Awareness with the 19th Sgt. Maj. of the Marine Corps

Video
2/21/2023
Thumbnail image of the Picking Your Brain podcast episode with Sgt. Maj. Troy Black

In this episode of Picking Your Brain, TBICoE Branch Chief, Capt. Scott Cota and clinical moderator Amanda Gano interview the 19th Sgt. Maj. of the Marine Corps, Sergeant Major Troy Black. The interview covers topics such as the DOD's Warfighter Brain Health Initiative, the commandant of the Marine Corps' Force Design 2030 efforts, and how warfighter brain health is a key factor in the human performance of Marines.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBICoE Podcasts | TBI Educators | TBI Provider Resources | TBI Patient and Family Resources | Be a Brain Warrior: Protect. Treat. Optimize.

Optimizing Warfighter Brain Health and Performance

Video
2/21/2023
Thumbnail image of TBICoE's Dr. Sloley video.

Traumatic Brain Injury Center of Excellence research support cell chief, Dr. Stephanie Sloley, discusses her role in the organization and the importance of collaborative efforts in examining traumatic brain injuries. Dr. Sloley discusses the mission and vision of TBICoE and the importance of optimizing warfighter brain health and performance.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBICoE Research | Education & Training Events | TBI Educators | Be a Brain Warrior: Protect. Treat. Optimize.

Interview with the SEAC: TBI from a Joint Perspective

Video
7/18/2022
Picking Your Brian Podcast. Interview with the SEAC: TBI from a Joint Staff Perspective

In this episode of Picking Your Brain, Traumatic Brain Injury Center of Excellence Branch Chief Capt. Scott Cota and clinical moderator Amanda Gano interview the Senior Enlisted Advisor to the Chairman of the Joint Chiefs of Staff (SEAC), Ramón Colón-López. The discussion covers the health impacts of TBI and blast-related concussion stemming from the demands of combat and training. The SEAC also addresses the importance of maintaining medical readiness through education and military leadership. Listen to more Picking Your Brain episodes at www.health.mil/TBIPodcasts, on DVIDS, or wherever you listen to podcasts.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBICoE Podcasts | TBI Provider Resources | TBI Patient and Family Resources | TBI Educators | Centers of Excellence

One Airmans Recovery from TBI

Video
3/28/2022
Master Sergeant Stalnaker laying in a hospital bed

After a motorcycle accident, Master Sergeant Stalnaker started having symptoms of traumatic brain injury, or TBI. He tells his story about his symptoms and his road to recovery from physical and emotional wounds as a result.

Recommended Content:

Traumatic Brain Injury Center of Excellence

A Retired Navy SEAL Discusses his TBI

Video
3/9/2022
Retired Navy SEAL Edward Rasmussen

Retired Navy SEAL Edward Rasmussen discusses his TBI, and urges others to seek treatment if they have symptoms. If you’re experiencing symptoms of TBI, visit health.mil/TBI to learn about the resources available to you.

Recommended Content:

Brain Injury Awareness | Traumatic Brain Injury Center of Excellence

One Airman's Recovery from TBI

Video
3/9/2022
Master Sergeant Stalnaker in the hospital

After a motorcycle accident, Master Sergeant Stalnaker started having symptoms of traumatic brain injury, or TBI. He tells his story about his symptoms and his road to recovery from physical and emotional wounds as a result. If you’re experiencing symptoms of TBI, visit health.mil/TBI to learn about the resources available to you.

Recommended Content:

Brain Injury Awareness | Traumatic Brain Injury Center of Excellence

TBI Prevention

Video
2/9/2022
Learn more at health.mil/TBI

It is important for everyone to remember that we only have one brain. That means taking the necessary to protect your brain when engaging in sports, driving, or during exercises while on-duty.

Recommended Content:

Traumatic Brain Injury Center of Excellence

PRA Training Video 6: The Return to Duty Screening

Video
7/22/2021
Thumbnail image of PRA training video 6, the return to duty screening

In this lesson, we cover how to perform the Return to Duty, or RTD screening, which now includes both vestibular/physical and neurocognitive examinations. The purpose of the RTD screening is to objectively measure whether a service member is ready for return to full duty. Each video in the Progressive Return to Activity training series is designed to support primary care providers' ability to manage concussion/traumatic brain injury (TBI).

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Provider Resources | Provider Education

PRA Training Video 8: Clinical Case Scenario

Video
7/22/2021
Thumbnail image of PRA training video 8, clinical case scenario.

This is an interactive clinical case scenario to test your understanding in applying the Progressive Return to Activity (PRA). We hope this will help medical providers become more familiar with the PRA process when treating service members with concussion. Each video in the PRA training series is designed to support primary care providers' ability to manage concussion/traumatic brain injury (TBI).

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Provider Resources | Provider Education

PRA Training Video 3: Understanding Relative Rest

Video
7/22/2021
Thumbnail image for PRA Training video 3, understanding relative rest

In this lesson we explain the differences between complete rest and relative rest in a staged concussion recovery process, and provide examples of activities that promote relative rest. The revised Progressive Return to Activity (PRA) Clinical Recommendation uses the term 'relative rest' to emphasize the importance of early introduction of physical and cognitive activities that do not provoke symptoms following TBI. Each video in the PRA training series is designed to support primary care providers' ability to manage concussion/traumatic brain injury (TBI).

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Provider Resources | Provider Education

PRA Training Video 2: Six Major Changes

Video
7/22/2021
Thumbnail image of PRA Training Video 2, Six Major Changes

In this lesson we review the six major changes in the TBICoE's revised 2021 Progressive Return to Activity (PRA) Clinical Recommendation that differ from the original recommendation. The changes reflect the latest TBI research, and will make it easier for providers to manage the recovery process and return service members with concussion to full duty as quickly and safely as possible. Each video in the PRA training series is designed to support primary care providers' ability to manage concussion/traumatic brain injury (TBI).

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Provider Resources | Provider Education

PRA Training Video 1: PRA Overview

Video
7/22/2021
Thumbnail image of PRA training video 1, PRA overview.

In the first of TBICoE's Progressive Return to Activity (PRA) video training series, you will learn about the reasons for using a progressive return to activity process and receive an overview of the 2021 PRA algorithm and its associated tools. By the end of lesson one, providers will better understand the PRA process, and explain that process to service members diagnosed with concussion. Each video in the PRA training series is designed to support primary care providers' ability to manage concussion/traumatic brain injury (TBI).

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Provider Resources | Provider Education

PRA Training Video 7: Symptom-Guided Management and Specialty Referral Guidance Tables

Video
7/22/2021
Thumbnail image of PRA training video 7, the symptom-guided management and specialty referral guidance tables.

This lesson covers how to use the Progressive Return to Activity, or PRA's Symptom-Guided Management and Specialty Referral Guidance tables. This lesson also details primary care management strategies for service members who are not progressing as expected in the PRA. Each video in the Progressive Return to Activity training series is designed to support primary care providers' ability to manage concussion/traumatic brain injury (TBI).

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Provider Resources | Provider Education
<< < 1 2 > >> 
Showing results 1 - 15 Page 1 of 2
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