Medical Evacuation

Medical Evacuation of Patients with TBI

Care for combat wounded service members is expedited though a medical transport system which begins on the battlefield with initial life saving treatment, continues through combat support hospitals and regional medical centers, and extends into the continental United States (CONUS).  There, acute care intensifies with further medical stabilization and supportive TBI care in a rapid sequence of events that ensures timely identification and treatment of injuries. The medical assets at each level of care are different, but the goal for patients with traumatic brain injury is the same: to optimize functional outcomes.

Service members sustaining moderate to severe TBI while in OEF/OIF are given emergent treatment at military facilities in theater. Once stabilized, the service member is transported to Landstuhl Regional Medical Center (LRMC) by highly skilled United States Air Force (USAF) critical care transport teams. At LRMC, there is a full complement of medical professionals that provides round the clock care to injured service members. Commonly, trauma surgery, neurosurgery, neurology, and critical care doctors and nurses implement treatment plans according to national TBI care guidelines. This may involve additional medical stabilization, imaging and procedures. If needed, specialists such as orthopedics, plastic surgeons and others may be consulted.

Once all injuries are identified and initial treatment started, the patient is evacuated stateside to one of the designated inpatient TBI centers: Walter Reed Army Medical Center (WRAMC), National Naval Medical Center (NNMC), or Brooke Army Medical Center (BAMC). This cycle of evacuation can occur in as few as seventy-two hours — much more quickly than in previous conflicts which sometimes took thirty days or more.

It is important to remember that the vast majority of brain injuries are concussions. Over 80% of service members sustaining a concussion will not require evacuation.

Recommendations developed by military and civilian experts, including those engaged in National Football League (NFL) and National Collegiate Athletic Association (NCAA) research, are utilized to evaluate and carefully monitor those with concussion. For those with symptoms persisting longer than two weeks, further work-up may be indicated.

Once again, the initial conduit is through LRMC. The injured may undergo testing to help determine if symptoms are related to a TBI or another condition. Efforts to control certain symptoms such as headache are started. Once it is determined that additional TBI treatment is needed, arrangements are made for stateside transfer.

As with more severe injury, patients with concussion are transported via the USAF aeromedical evacuation program. Those with concussion generally do not require inpatient medical services. As a result, they may be evacuated to their home duty station if the local military treatment facility has adequate TBI resources. In the event the home duty station does not have appropriate TBI assets, the service member is transferred to a stateside location that does. Service members may be referred to medical facilities hosted by another branch of service if needed.