Army TBI Program Overview

MAJ Sarah B. Goldman

Army Traumatic Brain Injury Program Director

Office of the Surgeon General

25 FEB 2013

UNCLASSIFIED

UNCLASSIFIED Slide 2 25 February 2013

194,561

42,083

2,527

3,949

10,210 Mild

Moderate

Severe

Penetrating

Not Classifiable

147,536

34,419

34,458

36,917

Army

Navy

Air Force

Marines

Proportion of Diagnosed TBIs by

Service in all DoD personnel

worldwide from 2000-2012 Q2*

Proportion of Diagnosed TBIs by

Severity Level in all DoD personnel

worldwide from 2000-2012 Q2**

Proportion of Diagnosed TBIs Worldwide Since 2000

* Source: Defense Medical Surveillance System, Theater Medical Data Store. Includes both deployed and non-deployed personnel.

** Diagnosed TBI cases does not reflect the true proportion of all TBIs occurring in the military population.

UNCLASSIFIED Slide 3 25 February 2013

Number of Diagnosed TBIs in the Army: Worldwide Data from 2010-2012 Q2

* Source: Defense Medical Surveillance System, Theater Medical Data Store. Includes both deployed and non-deployed personnel.

Number of Traumatic Brain Injury cases in U.S. Army Soldiers worldwide from

2000-2012 Q2. The diagnosis and severity of injury were obtained using ICD-9 codes.*

10,932

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

Total Army TBI through 2012 Q2

200 201 166 200 233 232 333 401 525 614 384 329

1,647 1,425 1,318 1,094 1,112 1,006 1,412

2,458

2,296

2,576 2,826

3,287 2,748

3,393 3,758

4,216 4,941

4,951

7,505

11,461

14,286 13,994

15,395 15,759

18 23 12 15 15 16 16 179

2,573

1,862 1,361 1,832

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Nu

mb

er

of

Arm

y S

old

iers

wit

h Id

en

tifi

ed

TB

I

Calendar Year in which Injury Occurred

Severe or Penetrating

Moderate

Mild

Non-classifiable

UNCLASSIFIED Slide 4 25 February 2013

0

5,000

10,000

15,000

20,000

25,000

30,000

Garrison Associated Deployment Associated

Garrison vs. Deployed TBI

• 84% of all DoD TBIs from

2000-2011 occurred in

Garrison

• Way ahead: Develop Army

policy analogous to Theater

– Mandatory medical evaluation

– Mandatory 24 hours downtime

– Mandatory Reporting

– Medical clearance before returning

to duty

• Bottom Line: TBI will remain an

military concern long after

2014 Afghanistan troop

withdrawal

Nu

mb

er

of T

BI C

ase

s W

orld

wid

e

Source: Armed Forces Health Surveillance Center

DoD TBI Cases Worldwide 2000-2011

UNCLASSIFIED Slide 5 25 February 2013

Enterprise Management Strategy: “Educate, Train, Treat, Track”

UNCLASSIFIED Slide 6 25 February 2013

Army Garrison TBI Care

CATEGORY 1: Providing inpatient and

outpatient care for Soldiers with mild,

moderate, severe and penetrating TBI

CATEGORY 2: Providing inpatient and

outpatient care for Soldiers with mild and

moderate TBI

CATEGORY 3: Providing outpatient

medical and rehabilitative care for Soldiers

with mild and moderate TBI

CATEGORY 4: Providing outpatient

medical care for Soldiers with mild TBI

CATEGORY 1

Ft Gordon

Ft Lewis

Ft Sam Houston

Landstuhl (1b)

Tripler (1b)

WRNMMC

CATEGORY 2

Ft Benning

Ft Bliss

Ft Bragg

Ft Campbell

Ft Hood

CATEGORY 3

Bamberg

Baumholder

Ft Belvoir

Ft Carson

Ft Drum

Ft Knox

Ft Polk

Ft Riley

Ft Stewart

Schofield Barracks

Vicenza

Vilseck

Embedded Neurocognitive Assessment Tool

(NCAT) Capability

TBI Tele-Health Capability

Joint Task Force National Capitol Region Medical

(JTF CapMed)

Defense and Veterans Brain Injury Center Sites

WESTERN

Region

SOUTHERN

Region

NORTHERN

Region

EUROPEAN

Region

Aberdeen

Camp Atterbury

Camp Shelby

Camp Zama

Carlisle Barracks

DiLorenzo

Ft Buchanan

Ft Detrick

Ft Dix

Ft Eustis

Ft Huachuca

Ft Irwin

Ft Jackson

Ft Leavenworth

Ft Lee

Ft Leonard Wood

Ft McCoy

Ft Meade

Ft Myer

Ft Richardson

Ft Rucker

Ft Sill

Ft Wainwright

Grafenwoehr

Heidelberg

Hohnfels

Illescheim

Katterback/Ansbach

Korea

Redstone Arsenal

Schweinfurt

SHAPE

Stuttgart

West Point

Wiesbaden

CATEGORY 4

b

PACIFIC

Region

b

JTF CapMed

UNCLASSIFIED Slide 7 25 February 2013

Required TBI Training

UNCLASSIFIED Slide 8 25 February 2013

MRMC: Continuum of Care Determines

Research Approach

8. Reset

Objective Measure of Head

Impact/Blast Exposure

Valid Criteria & Objective mTBI/

Concussion Screening Tool

Head Impact Blast Injury Dosimeter

Validated Definition and Technologies:

EEG, TCD, Eye Tracking, Vestibular Ocular

Assessment, Biomarkers

RTD Standards, Evaluation/

Measurement

Medications & Novel

Interventions

Cognitive, Behavioral,

Neurological & Imaging

Assessments : (CT, fMRI, DTI,

MRS, ICP Device, etc.)

7. TBI/

Concussion

Recovery

6. TBI/

Concussion

Treatment

Evidence-Based Rehabilitation

Protocols, Measures of

Rehab Progress

Portable Fieldable Diagnostic Device

(In Theatre & Garrison)

Pharmaceutics &Surgical

Technology

Recovery Timecourse & Rehabilitation

Valid RTD Standards & Measures of

Rehabilitation

5. TBI/

Concussion

Assessment

4. TBI/ Concussion

Screening

(DoD Guidelines)

RDT&E: Injury Prevention Combat Casualty Care

3. Possible TBI/

Concussion from

Impact or Blast

Return to Duty/Disability/Reclassification Assessment

2. TBI/

Concussion

Prevention/

Education &

Training

Nutraceuticals, Standards for

Helmets, Education/CPG’s

for Soldiers, Leaders & Service

Providers

Medical Standards for

Protective Equipment

Continuing Education and Reinforcement for Soldiers, Leaders and Service Providers

Psych Health and Related Symptoms

1. B

asic

Scie

nce

UNCLASSIFIED Slide 9 25 February 2013

TBI Research Examples

Biomarker Research PEO Soldier Helmet Sensors

DARPA Blast Gauge Neuropathology Studies: Chronic Traumatic

Encephalopathy

Tau Proteins

LED USB Port

Handheld Devices

Combat Medic

Benchtop System

UNCLASSIFIED Slide 10 25 February 2013

National Football League - Army Initiative

• NFL- Army Initiative to promote

Concussion Awareness

• Cultural change in seeking care

for invisible injuries

• Players and Soldiers/Marines

share a “warrior mentality”

• Minimal stigma with being told

you have to sit out but there is

stigma with asking to sit out

– Highlights importance of “3rd

party” involvement