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. 

Skip subpage navigation

TBI Resources for Medical Providers

TBICoE develops practical, easy-to-use clinical recommendations and tools to support military and civilian health care providers in assessing and treating service members and veterans who have sustained a TBI. Providers can access clinically relevant information and resources that address common symptoms associated with mild TBI, such as headache, sleep disturbances, and vision problems. Most clinical recommendations have related patient resources to help educate patients through recovery. Check out the Patient and Family Resources section to locate fact sheets, patient resources, and family and caregiver support tools.

Interested in learning more about the potential effects of low-level blast exposure? Discover which occupations and heavy weapon systems are associated with increased risk of LLB exposure and learn how to best document, manage, and care for your patients—to optimize warfighter brain health.

TBI educators, known as regional education coordinators, are available to provide training on our clinical recommendations and tools. Check out TBICoE's Education and Training Events page for details or email the team to schedule specific trainings for yourself or your team. Supplemental Provider Education materials are also available.

Acute Concussion Care Pathway

In order to standardize acute concussion assessment and care across the MHS, DHA established the Acute Concussion Care Pathway as part of the FY21 Quadruple Aim Performance Plan.

The goal of the ACC Pathway is to improve recovery times and outcomes by utilizing a multi-modal assessment tool at the time of injury—the Military Acute Concussion Evaluation version 2—and to ensure timely access to repeat evaluations with personalized treatment protocols in alignment with a progressive return to activity process. By establishing a standard pathway of care for mild TBI, providers across the MHS can ensure a reduction in unwarranted variation and foster an integrated system of readiness and health.

Supporting the goal of the ACC Pathway, the DHA Procedural Instruction 6490.04, titled “Required Clinical Tools and Procedures for Assessment and Clinical Management of Mild Traumatic Brain Injury /Concussion in Non-Deployed Setting,” establishes the DHA's required clinical tools and procedures for management of mild TBI, or concussion, in a non-deployed setting. Specifically, the use of the MACE 2 and a PRA framework for the assessment, management, and rehabilitation of all patients with a mild TBI.

The ACC Pathway—a standardized assessment and treatment plan for acute concussion, mandates:

  1. Use of the MACE 2 for acute assessment at the initial appointment 
  2. Follow-up within 72 hours after diagnosis of mild traumatic brain injury
  3. Completion of a progressive return to activity process prior to return to full duty

This infographic and educational video focus on standardizing the nomenclature for the ACC Pathway, delineating how each element intertwines to meet the objective of improving concussion outcomes across the MHS. 

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.  What is the Acute Concussion Care Pathway?

Download the ACC Pathway Infographic

TBICoE also offers a quarterly "Application of Acute Concussion Care Pathway: MACE 2 & PRA" virtual training. Attendees may earn two CEUs through the Defense Health Agency Continuing Education Program Office.

The DOD published the DODI 6490.11, "DOD Policy Guidance for Management of Mild Traumatic Brain Injury/Concussion in the Deployed Setting" establishing policy, assigning responsibilities, and providing procedures on the management of mild TBI, also known as concussion, in the deployed setting.

TBICoE's MACE 2, PRA clinical recommendation, Recurrent Concussion Evaluation, and ICD-10 Coding Guidance for TBI support the ACC Pathway, the DHA-PI 6490.04, and the DODI 6490.11 and are available for download below.

 

MACE 2

The 2018 MACE 2 is an acute assessment tool for all medically trained personnel who treat service members involved in a potentially concussive event. The clinical tool incorporates current state-of-the-science traumatic brain injury information, including vestibular-ocular-motor screening.

Download the MACE 2 and supporting materials.

 

Progressive Return to Activity

The 2021 Progressive Return to Activity: Primary Care for Acute Concussion Management clinical recommendation is an evidence-based return to activity protocol for primary care managers and concussion/TBI clinic providers.

Download the Progressive Return to Activity: Primary Care for Acute Concussion Management clinical recommendation and Patient and Leadership Guide.

 

Recurrent Concussion Evaluation

Download the Recurrent Concussion Evaluation

 

ICD-10 Coding Guidance for TBI

Download the ICD-10 Coding Guidance for TBI

Clinical Recommendations and Support Tools for Mild TBI

TBICoE optimizes clinical care by combining evidence from medical literature, health care research, and expert opinion to develop and provide clinical recommendations and tools to help providers deliver evidence-based treatment and address the challenges associated with mild TBI.

  • Clinical recommendations provide guidance on assessing and managing mild TBI symptoms.
  • Clinical support tools offer an algorithmic approach to evaluating, managing, and referring mild TBI patients for specialty care.
  • Training material to show providers how to identify and treat patients with mild TBI-related symptoms.
  • Fact sheets and patient guides that provide tips and tools to help service members and veterans cope with a mild TBI.
 

*NEW* Neuroendocrine Dysfunction Following Concussion/Mild TBI Provider Fact Sheet

Learn more and download this new provider tool here!

Neuroendocrine Dysfunction Screening Following Concussion/Mild TBI

 

Neuroimaging Following Concussion/Mild TBI

 

Dizziness and Visual Disturbances Following Concussion/Mild Traumatic Brain Injury

 

Sleep Disturbances Following Concussion/Mild TBI

 

Headache Following Concussion/Mild TBI

 

Cognitive Rehabilitation Following Mild to Moderate TBI

 

Neurocognitive Assessment Tool (NCAT) Testing Following Concussion/Mild TBI

 

Additional Clinical Support Tools

TBICoE also offers the following tools to assist in the identification, treatment and management of patients with mild TBI in deployed and non-deployed settings.

Find and download the additional tools here.

You also may be interested in...

Publication
Feb 23, 2024

Assessment and Management of Dizziness and Visual Disturbances Following Concussion/Mild Traumatic Brain Injury

.PDF | 1.03 MB

This clinical recommendation provides medical staff with a single, comprehensive reference for the assessment and management of dizziness and visual disturbances following mild TBI/concussion. Dizziness and visual disturbances often present with overlapping symptoms and should prompt a provider to perform a visual and dizziness—or vestibular—assessment.

Publication
Feb 20, 2024

Progressive Return to Activity: Primary Care for Acute Concussion Management

.PDF | 505.25 KB

This clinical recommendation is an evidence-based return to activity protocol for primary care managers and concussion/traumatic brain injury clinic providers. The PRA is a six-step approach that begins after the provider performs the MACE 2 (Military Acute Concussion Evaluation 2) and the patient is diagnosed with a concussion, also known as a mild TBI.

Calendar Event
Jan 22, 2024

Acute Concussion Care Pathway: MACE 2 & PRA Training

The Traumatic Brain Injury Center of Excellence hosts a combined Military Acute Concussion Evaluation 2 and Progressive Return to Activity clinical recommendation virtual training. Attendees may earn two CEUs through the Defense Health Agency Continuing Education Program Office.

Publication
Dec 14, 2023

March 22, 2024, TBICoE QES Event: Prolonged Field Medicine and TBI

.PDF | 220.63 KB

A challenge of modern-day warfare is determining the course of care when a battlefield injury results in traumatic brain injury. Join the Traumatic Brain Injury Center of Excellence for a discussion on TBI care in austere environments.

Publication
Dec 14, 2023

2024 TBICoE Quarterly Education Series Schedule

.PDF | 209.46 KB

Save the dates with a complete 2024 schedule of the Traumatic Brain Injury Center of Excellence's Quarterly Education Series. The QES is an enterprise-wide learning opportunity for Military Health System stakeholders. Since inception, the QES provides trainings and education events that are relevant to the MHS, discussing specialty topics and current ...

Publication
Dec 4, 2023

Acute Concussion Care Pathway: MACE 2 and PRA Training Flier

.PDF | 228.63 KB

The Traumatic Brain Injury Center of Excellence is hosting a combined Military Acute Concussion Evaluation and Progressive Return to Activity clinical recommendation virtual training. Attendees may earn two CEUs through the Defense Health Agency Continuing Education Program Office. Download the flier for the complete 2024 training schedule.

Infographic
Nov 29, 2023

TBICoE's Low-Level Blast Research Infographic

What is TBICoE doing to help warfighters exposed to low-level blast? Leading the charge: 1. Collaborated on Military weapons training studies and Epidemiology studies 2. Led health and performance efforts in support of the Section 734 Program Advancing the science: 1. Measured LLB exposure effects on performance 2. Provided recommendations on LLB surveillance 3. Advanced DOD’s understanding of LLB health and performance effects Answering the call: 1. Outlined next steps for LLB research 2. Helped to develop guidance for managing brain health risk from blast overexposure 3. Recommended the development of a tool to capture career blast exposure These efforts are in support of the Warfighter Brain Health Initiative LLB Relevant Aims 1. Understand the known and emerging threats and hazards to brain health 2. Monitor warfighters for brain exposures 3. Reduce risk of brain exposures that may negatively impact brain health

This infographic illustrates TBICoE's research activity on understanding how low-level blast influences warfighter brain health. This work directly supports Line of Effort 2 of the Warfighter Brain Health Initiative. Learn more about low-level blast exposure and TBI at health.mil/LLB.

Publication
Nov 29, 2023

TBICoE's Low-Level Blast Research Efforts Infographic

.PDF | 2.12 MB

This infographic illustrates TBICoE's work to better understand how low-level blast influences warfighter brain health. These efforts directly support Line of Effort 2 of the Warfighter Brain Health Initiative.

Publication
Sep 29, 2023

TBICoE Research Review: Mild TBI and PTSD

.PDF | 435.28 KB

This research review provides an in-depth summary of the available clinical research on the topic of co-morbid mild traumatic brain injury and posttraumatic stress disorder. Specifically, this review will address symptoms, anatomy, diagnosis, and treatment of mild TBI, PTSD, and the unique circumstances associated with the presentation of both.

Publication
Sep 29, 2023

Mild TBI and PTSD Clinical Pearls

.PDF | 924.82 KB

TBICoE's "Mild Traumatic Brain Injury and Posttraumatic Stress Disorder Clinical Pearls," is a new supplemental product to the detailed research review. This resource is designed to be brief and provide key actionable “clinical pearls” that should be considered in the treatment of service members with comorbid mild TBI and PTSD.

Video
Sep 21, 2023

TBI and Low-Level Blast Exposure: What Medical Providers Need to Know

TBI and Low-Level Blast Exposure: What Medical Providers Need to Know

This educational video, produced by the Traumatic Brain Injury Center of Excellence, focuses on the effects of low-level blast and traumatic brain injury. Its purpose is to provide supplemental information on low-level blast to health care providers and beneficiaries.

Technical Document
Jul 20, 2023

Infographic: What is the Acute Concussion Care Pathway?

.PDF | 714.95 KB

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 ...

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 ...

Last Updated: November 30, 2023
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on X Follow us on YouTube Sign up on GovDelivery