Neurotrauma & Traumatic Brain Injury

The Neurotrauma and Traumatic Brain Injury Portfolio is a requirements-based program that seeks to improve the far-forward capabilities of military diagnostic and treatment for the spectrum of TBI severities, with emphasis on moderate and severe TBI and polytrauma under Multi-Domain Operations in prolonged field care scenarios.

Diagnosis and treatment of brain injury are recognized as high and moderate priority Army medical gaps. Army Medical Units lack the ability to assess the existence and severity of brain trauma to achieve a 99% accuracy for diagnosis and effectively treat 100% of soldiers who have suffered a brain injury.

To address these critical capability gaps, the program’s top research goals include:

Developing life-saving resuscitation interventions for TBI and polytrauma.
Fielding point-of-injury therapeutic interventions to mitigate secondary effects of brain injury.
Enabling far-forward, rapid diagnostic capabilities to diagnose and monitor TBI in a prolonged field care environment.
Developing monitoring and recording technologies for management and maintenance of TBI in a prolonged field care environment
Maintaining Warfighter lethality in the presence of brain injury until tactical extraction is possible

MULTI-DOMAIN OPERATIONS

Past and current wartime strategy has operated under the assumption that the United States will maintain air, land, maritime, space and cyber superiority, allowing battlefield casualties to be evacuated from ROC 1 in less than 2 hours. As our adversaries work to exploit our weaknesses, future combat scenarios will not allow us to assume constant superiority.

A new outlook on future military operations is referred to as Multi-Domain Operations (MDO), which outlines that in future conflicts:

Triage and evacuation may not be possible in the sub-acute timeframe, resulting in the necessity to maintain field care for an extended amount of time (Figure 1).
Temporary loss of Wartime superiority will substantially lengthen the timelines in which each ROC can be accessed by the Warfighter, increasing the need for far-forward diagnostic and treatment interventions.
Small, highly mobile forces may be necessary, limiting the time and personnel available to attend to casualties.
Lack of consistent communication to higher echelons of care and logistical support will necessitate more independent medical triage and care.


Figure 1: As a result of Multi-domain Operations, roles of care are expected to change due to prolonged care scenarios with lack of immediate patient evacuation.

TBI is a complex and multi-faceted disease state resulting from a blow, jolt or direct blast overpressure wave to the head. Following the primary injury, secondary cascades such as altered metabolism, increased inflammation, and aberrant protein processing result in cell death and injury exacerbation. TBI management is further complicated with polytrauma, under which most moderate and severe TBIs are seen. Diagnosis and treatment of TBI in the acute setting can significantly improve long-term functional outcomes and reduce injury severity. Development of diagnosis and treatment interventions to reduce injury severity and improve casualty maintenance that can be employed at ROC 1, over the course of the extended time following injury, will facilitate reductions in permanent brain damage, better Warfighter care and improved return-to-duty times.

The following Lines of Effort address the critical Army medical gaps while understanding MDO:

LINES OF EFFORT

#1. INNOVATIVE THERAPEUTIC STRATEGIES FOR POINT-OF-INJURY TO IMPROVE OUTCOMES ACROSS THE SPECTRUM OF ACUTE TBI SEVERITY INCLUDING POLYTRAUMA

Develop new and/or improve initial life-saving interventions that are deployable to far-forward combat environments while considering Multi-Domain Operations.
Develop interventions to mitigate secondary brain injury and promote repair and recovery during prolonged field care.
Enable medics to extend TBI casualty care throughout the Golden Day

#2. RAPID DETECTION AND DIAGNOSIS OF TBI AT POINT-OF-INJURY, INCLUDING PROGNOSTIC INDICATORS FOR PROLONGED FIELD CARE

Improve the diagnostic and prognostic capabilities for management of the spectrum of TBI severities and polytrauma at the point-of-injury through the post-acute period

Develop capabilities that are deployable to far-forward combat environments while considering Multi-Domain Operations
Develop technologies that provide a complete, objective characterization of type of injury (ie diffuse or localized), cell type specificity and localization of brain injury to inform personalized treatment intervention following TBI

#3. POINT-OF-INJURY CAPABILITIES TO MONITOR CRITICAL PHYSIOLOGICAL PARAMETERS

Improve neurotrauma/polytrauma casualty care at ROC 1 and ROC 2 by enabling relevant monitoring, recording, and transmission of patient physiological parameters
Develop systems with capability of seamless care and communication from point of injury, through prolonged field care considering Multi-Domain Operations.
Integrate automated, closed loop systems to assist in the management of moderate-severe TBI in the prolonged field environment