Landstuhl RMC, Germany: Local DVBIC Activities

Landstuhl Regional Medical Center (LRMC), Germany

The definition of a mild TBI (mTBI)/concussion as defined by the American Congress of Rehabilitation Medicine is: a traumatically induced structural injury and/or physiological disruption of brain function as a result of an external force that is indicated by new onset or worsening of at least one of these symptoms:

• Loss of Consciousness
• Loss of memory for event immediately before or after the accident
• Any alteration in mental state at the time of the injury (dazed, disorientated, confused
• Presence of focal neurological deficits
• If given, GCS 13 or greater.

Landstuhl Regional Medical Center has a unique position as being the hourglass that all military personnel pass through if they have a medical problem, when they have been deployed in OIF/OEF. At Landstuhl we screen every patient that arrives from downrange, for mTBI/concussion, regardless of their medical reason for being here. The current process for inpatients, involves checking the daily ward census, identifying the patient that has been in OIF or OEF and cross checking with the TBI data base.

Outpatients are given an appointment time to have their screening done, within a day or two of arrival. Protocols are set-up to try and ensure that the patient has had adequate rest before screening takes place. The screening questions ask about exposure to any kind of blast, vehicular crash, fall, a gunshot wound above the shoulders, blunt object to the head or fragment wounds. If an exposure has occurred specifics about the event are obtained. The interview then continues, to check for any possible symptoms of an mTBI/concussion, either at the time of the incident and/or continuing to the present time.

Once a patient has been identified as a positive TBI a MACE is preformed, unless there are
circumstances that preclude this, such as heavy sedation and intubation.

The MACE (Military Acute Concussion Evaluation) is a quick assessment of their orientation to time, immediate and delayed memory, and concentration.

In addition, a report of their head CT or MRI is reviewed.

At the conclusion of the interview, all patients receive education on TBI.

The information is recorded and then entered into the LRMC TBI data base, essentris (inpatient data base) and AHLTA. The above information is used to decide where the patient is manifested to. When they are still symptomatic they will be sent to a DVBIC head injury site to ensure they receive the most comprehensive care possible.

The ultimate goal is to interview 100% of the patients. This process is doing the job of identifying those who may have symptoms and don’t realize they have had a TBI. It also helps to direct the patient to a center that can offer appropriate treatments that shorten the length of the symptoms.