Management of traumatic brain injury in a large-scale combat environment

The United States Armed Forces face the potential reemergence of large-scale combat operations (LSCO) as the predominant operating environment of the 21st century as a result of growing geopolitical conflict between the United States and its near-peer rivals. In a LSCO environment, the Military Health System (MHS) may encounter casualty rates that could quickly overwhelm existing procedures and services. Many of these casualties are likely to present with injuries to the head and brain, including traumatic brain injury (TBI). Screening, triage, and evacuation of service members with TBI will be complicated by high casualty rates, ubiquitous surveillance, and contested movement corridors. Given these complexities, it is paramount that the Department of War (DOW) develop and continuously refine a framework for the clinical and administrative management of TBI in LSCO. This narrative review presents factors informing TBI management in the setting of a modern, near-peer conflict. A Taiwan defense scenario is used as the pacing threat for a LSCO scenario. Specific emphasis is placed on the management of mild TBI (mTBI). A depiction of a proposed algorithmic approach to mTBI will be presented. Research considerations, knowledge gaps, and technological advances relevant to TBI casualty management are discussed.