03/04/2026
Traumatic brain injuries in the tactical environment are often underestimated, under-recognized, and operationally devastating.
From blast exposure and breaching operations to falls, vehicle incidents, and blunt force trauma, TBIs don’t always present with dramatic findings. A patient may be awake, talking, and still experiencing evolving intracranial pathology. In high-threat or high-tempo settings, subtle neurologic decline can be missed if you’re not deliberately looking for it.
For the prehospital tactical medical provider, this means maintaining a high index of suspicion. Repeated blast exposure without obvious injury, transient loss of consciousness, worsening headache, vomiting, unequal pupils, declining GCS, or behavior changes should immediately raise concern. Hypoxia and hypotension must be aggressively avoided — both dramatically worsen outcomes in brain-injured patients.
March is Brain Injury Awareness Month - a great time to review TBI protocols and check your protective head gear to ensure you remain uninjured and operational.