655 JRRD JRRD Volume 46, Number 6, 2009 Pages 655–666 Journal of Rehabilitation Research & Development Acute clinical care and care coordination for traumatic brain injury within Department of Defense Michael S. Jaffee, MD; 1 Kathy M. Helmick, CRNP; 1 Philip D. Girard, MS; 1–2* Kim S. Meyer, APRN; 1 Kathy Dinegar, LICSW; 3 Karyn George, MS, CRC 1 1 Defense and Veterans Brain Injury Center, Walter Reed Army Medical Center (WRAMC), Washington, DC; 2 Manchester Department of Veterans Affairs Medical Center, Manchester, NH; 3 WRAMC, Washington, DC Abstract—The nature of current combat situations that U.S. military forces encounter and the use of unconventional weap- onry have dramatically increased service personnel’s risks of sustaining a traumatic brain injury (TBI). Although the true incidence and prevalence of combat-related TBI are unknown, service personnel returning from deployment have reported rates of concussion between 10% and 20%. The Department of Defense has recently released statistics on TBI dating back to before the wars in Iraq and Afghanistan to better elucidate the impact and burden of TBI on America’s warriors and veterans. Patients with severe TBI move through a well-established trauma system of care, beginning with triage of initial injury by first-responders in the war zone to acute care to rehabilitation and then returning home and to the community. Mild and mod- erate TBIs may pose different clinical challenges, especially when initially undetected or if treatment is delayed because more serious injuries are present. To ensure identification and prompt treatment of mild and moderate TBI, the U.S. Congress has mandated that military and Department of Veterans Affairs hospitals screen all service personnel returning from combat. Military health professionals must evaluate them for concus- sion and then treat the physical, emotional, and cognitive prob- lems that may surface. A new approach to health management and care coordination is needed that will allow medical transi- tions between networks of care to become more centralized and allow for optimal recovery at all severity levels. This article summarizes the care systems available for the acute manage- ment of TBI from point of injury to stateside military treatment facilities. We describe TBI assessment, treatment, and overall coordination of care, including innovative clinical initiatives now used. Key words: cognitive assessment, community reentry, loss of consciousness, medical evacuation, polytrauma, posttraumatic amnesia, rehabilitation, TBI, TBI screening, traumatic brain injury. INTRODUCTION The use of unconventional weaponry has increased the risk of traumatic brain injury (TBI) for military personnel engaged in current combat operations. Although the true incidence and prevalence of combat-related TBI is Abbreviations: AE = air evacuation, ANAM = Automated Neuropsychological Assessment Metrics, AOC = alteration of consciousness, CONUS = continental United States, DOD = Department of Defense, DVBIC = Defense and Veterans Brain Injury Center, GCS = Glasgow Coma Scale, LOC = loss of con- sciousness, LRMC = Landstuhl Regional Medical Center, MACE = Military Acute Concussion Evaluation, mTBI = mild TBI, MTF = military treatment facility, PTA = posttraumatic amnesia, RTD = return to duty, TBI = traumatic brain injury, VA = Department of Veterans Affairs, VAMC = VA medical center. * Address all correspondence to Philip D. Girard, Office of Telemedicine, Manchester VA Medical Center, 718 Smyth Road, Manchester, NH 03104; 603-617-0293; fax: 603-626- 6502. Email: Philip.girard@va.gov DOI:10.1682/JRRD.2008.09.0114