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Army issues new guidelines for TBI care

All soldiers involved in a blast, fall, vehicle crash or direct impact incident who lose consciousness or become dizzy afterward must be seen by a licensed medical provider as soon as possible, according to an Army All Activities Alert dated July 8.

“Concussion may severely impair soldier combat effectiveness leading to poor marksmanship, delayed reaction time and decreased concentration,” the alert states.

The alert also addresses the tendency of soldiers to memorize traumatic brain injury tests so they can deny having a concussion, and thus remain in the field — a trick many soldiers in Iraq laughingly admit to.

Research at the U.S. Military Academy shows that immediately going back out and being injured again, even if the second concussion is only minor, can prove fatal. And even a mild concussion, otherwise known as a mild traumatic brain injury, can cause visual disturbances, headaches and problems concentrating, which are not helpful in a battle.

In the long run, soldiers may develop post-concussive syndrome, which means their symptoms, if not treated, don’t go away. That can include dizziness, headaches, irritability, short-term memory loss and inability to sleep. Army research has shown that thousands of soldiers who should have been diagnosed with mild traumatic brain injury have not been.

Medics use the Military Acute Concussion Evaluation to determine if a soldier has a mild traumatic brain injury.

“The MACE has the potential to be memorized in advance, and soldiers may deny symptoms, leading to false negative evaluations,” the alert states. “However, alternate versions of the MACE are now available in theater.”

The next level of care has been laid out in the “Primary Care Management of Concussion in a Deployed Setting” clinical guideline, which will be available soon in Iraq and Afghanistan. In the meantime, it’s available here.

If a soldier’s symptoms persist for more than seven days, he should be referred to a level 2 or level 3 health care facility for examination with Automated Neuropsychological Assessment Metrics, or ANAM.

The alert also states that as of July 28, all soldiers deploying must have pre-deployment baseline cognitive testing with ANAM within 12 months of deployment. Testing will be expanded over the next two months and is available by contacting the Army Surgeon General’s office.

Oddly, the alert states that units do not need to keep the results of those tests on hand.

“Having baseline ANAM tests available for comparison is recommended, but not required, to aid in interpretation of post-injury ANAM tests for individual soldiers in theater,” the alert states.