By Jerry Harben (MEDCOM)
March is Brain Injury Awareness Month: A roadside explosion throws a Soldier against the side of his vehicle, with force that shakes his brain inside his skull. Another Soldier is in a traffic accident on the way to work, her head thrown forward into the windshield. A family member takes a hard fall during a sports game, hitting his head on the ground. Different situations, but often the same result - a mild traumatic brain injury (TBI), better known as a concussion.
A concussion is an injury that causes an alteration of the person's mental status. You had your "bell rung." You are dazed and confused. More serious brain injuries that cause unconsciousness for 30 minutes or more are usually quickly recognized, but concussions may be dismissed and go untreated."It's the same as we see in a football game on TV, but no one comes out and holds up two fingers for you to count," said Lt. Col. Lynne Lowe, TBI program director in the Office of The Surgeon General of the Army.
"If you have a car accident and the EMTs come, they are likely to tend to your bleeding and not check for concussion. You are likely to be so happy you're alive, you don't think about concussion," she added.
Most people recover from concussions in a short time - as long as they do not repeat the injury. "If someone has a concussion, we want them to be evaluated. It is very important that we protect them from getting another concussion before their brain heals," Lowe said.
Symptoms of concussion can include confusion, headaches, dizziness, ringing in the ears or nausea. These symptoms usually resolve within hours or a few days. Some people do have more persistent symptoms, which can include trouble sleeping, irritability or blurred vision.
"Providers can give medication for headaches or dizziness, and reassure them that they will be OK, because most people will be OK," Lowe said. "We teach them about what it means to have a concussion, and some of the warning signs of a worsening condition. If symptoms last longer, more formal testing can be done and, if needed, rehabilitation. It's a step care model, give them what they need, while always using our best judgment and available guidance."
"Just reassurance is very therapeutic in itself. Research proves that reassurance and education contribute to better outcomes," she said.The military has developed two tools to help medical professionals diagnose concussions.
The MACE (Mild Acute Concussive Evaluation) is part of treatment protocols used in the Department of Defense for injuries less than seven days old. A doctor or medic will ask about the subject's medical history and test memory and thinking ability. The subject may be asked to repeat a sequence of words or count backwards.
"It isn't that a bad score means you have a TBI," Lowe said. "The score means nothing by itself. It informs the decision, but doesn't form a diagnosis."The ANAM (Automated Neuropsychological Assessment Metric) is a computer-based neurocognitive test. From the full 45-minute test battery, the military has extracted several tests associated with brain injury that take about 15 minutes to complete.
Soldiers complete this test before deploying. If there is an incident that might produce a concussion, medical personnel on site can email for the baseline results and compare them to a post-injury test.Again, ANAM is not diagnostic, it is a tool used by a trained health-care provider to help in making a diagnosis.
The Army has conducted a well-publicized campaign to convince Soldiers who may have suffered a concussion in combat to seek treatment. But this is not an injury limited to combat, it can result from sports, vehicle accidents or everyday activities that produce falls or bumps.
"Whether you're going down a snow ramp on a tube, riding a bicycle or playing contact sports, it's a good idea to wear a helmet," said Larry Whisenant, chief of the safety office at Army Medical Command Headquarters. "Even children on a bicycle carrier should have helmets. It's such an easy thing to do and it can prevent a lot of grief."
"Some states don't require a helmet when riding a motorcycle, but the Army requires it of Soldiers regardless of state law," he added.Whisenant said safe helmets should bear a seal of approval from either the U.S. Department of Transportation or the Snell Memorial Foundation."A Nazi-style helmet that lacks a DOT or Snell seal is not good. It may look good riding down the highway, but it doesn't provide the protection you need," he commented.
Monday, March 9, 2009
Monday, March 2, 2009
Army changes access to medical care
Cynthia Vaughan
Chief, Public Affairs
OTSG/MEDCOM
The Army Surgeon General recognizes that access to care is not where it should be at all military treatment facilities (MTFs) and is taking aggressive steps to improve access and ensure that beneficiaries’ have access to quality care. Access is when our beneficiaries have the “The right provider, at the right time, in the right venue.” Several factors have contributed to what military healthcare providers across the services acknowledge are barriers to efficient and effective Access To Care. Most notable is the high number of war wounded and injured since hostilities began more than six years ago. This situation is amplified by a military healthcare system that was already understaffed and ill-equipped for the volume of war related injuries. Furthermore, our already stretched system was further stressed by a growing beneficiary population of active duty and reserve component military family members and retirees and their family members. To date, beneficiaries enrolled to Army military treatment facilities total more than 1.6 million. The most immediate shortfall for primary care providers is at 12 Army installations and The Army Surgeon General has provided the funding for those MTFs to hire the provider and support staff. Ensuring Army military treatment facilities’ capabilities are aligned with the number of beneficiaries they are charged to provide care for is the critical factor to improving access. The number of beneficiaries enrolled to an MTF must not exceed the MTF’s capacity. Over-enrollment at an MTF results in frustration for both the beneficiaries and the healthcare team. Of course, the second component is ensuring Primary Care Managers (PCM) are available for clinic to meet the demand of the enrolled population. We make a commitment to provide healthcare within DoD established access standards when beneficiaries chose to enroll to the MTF.There are key areas in our system that we have identified as friction points and they must be addressed and they are: phone service, online appointments, and follow-up appointments. The MEDCOM policy is to have 90 percent of appointment calls in the appointment call center’s queue answered within 90 seconds, have 80% of all primary care appointments on TRICARE on-line for internet booking, and to provide follow-up appointments during the healthcare visit or place beneficiaries on an automated appointment scheduling list. Army MTFs will optimize usage of the TRICARE contract. The Assistant Secretary of Defense for Health Affairs has published a policy that requires military treatment facilities to “offer the beneficiary a timely referral to obtain treatment in the TRICARE private sector network” if the MTF is unable to provide access to care within established standards. The Army Medical Command also recognizes how important it is for our patients to understand the various ways to obtain care and the processes involved, including how to obtain appointments by phone, via the internet (TRICARE On-Line), and more. MEDCOM will standardize Access To Care information on all MTF websites and in beneficiary information handouts provided during enrollment.Finally, MEDCOM is establishing a methodology for accounting for all beneficiary requests for access to primary care. Knowing who is requesting care, but not given an appointment at the MTF immediately, is just as important as knowing who did receive care. This detailed accounting will enable the MTF to make appropriate adjustments in enrollment and clinic schedules. While there are many areas under current review that will enhance access to care, The Army Surgeon General and his MTF commanders are working very hard to identify all Access To Care barriers and fix them; fully realizing that some will have relatively simple solutions, while others are more complex and will require more time. These efforts will result in markedly improved access and provide MTF commanders with the tools for maintaining situational awareness so that they may make the appropriate adjustments to provide care at the MTF or give the beneficiary the choice of receiving care in TRICARE civilian network.
Chief, Public Affairs
OTSG/MEDCOM
The Army Surgeon General recognizes that access to care is not where it should be at all military treatment facilities (MTFs) and is taking aggressive steps to improve access and ensure that beneficiaries’ have access to quality care. Access is when our beneficiaries have the “The right provider, at the right time, in the right venue.” Several factors have contributed to what military healthcare providers across the services acknowledge are barriers to efficient and effective Access To Care. Most notable is the high number of war wounded and injured since hostilities began more than six years ago. This situation is amplified by a military healthcare system that was already understaffed and ill-equipped for the volume of war related injuries. Furthermore, our already stretched system was further stressed by a growing beneficiary population of active duty and reserve component military family members and retirees and their family members. To date, beneficiaries enrolled to Army military treatment facilities total more than 1.6 million. The most immediate shortfall for primary care providers is at 12 Army installations and The Army Surgeon General has provided the funding for those MTFs to hire the provider and support staff. Ensuring Army military treatment facilities’ capabilities are aligned with the number of beneficiaries they are charged to provide care for is the critical factor to improving access. The number of beneficiaries enrolled to an MTF must not exceed the MTF’s capacity. Over-enrollment at an MTF results in frustration for both the beneficiaries and the healthcare team. Of course, the second component is ensuring Primary Care Managers (PCM) are available for clinic to meet the demand of the enrolled population. We make a commitment to provide healthcare within DoD established access standards when beneficiaries chose to enroll to the MTF.There are key areas in our system that we have identified as friction points and they must be addressed and they are: phone service, online appointments, and follow-up appointments. The MEDCOM policy is to have 90 percent of appointment calls in the appointment call center’s queue answered within 90 seconds, have 80% of all primary care appointments on TRICARE on-line for internet booking, and to provide follow-up appointments during the healthcare visit or place beneficiaries on an automated appointment scheduling list. Army MTFs will optimize usage of the TRICARE contract. The Assistant Secretary of Defense for Health Affairs has published a policy that requires military treatment facilities to “offer the beneficiary a timely referral to obtain treatment in the TRICARE private sector network” if the MTF is unable to provide access to care within established standards. The Army Medical Command also recognizes how important it is for our patients to understand the various ways to obtain care and the processes involved, including how to obtain appointments by phone, via the internet (TRICARE On-Line), and more. MEDCOM will standardize Access To Care information on all MTF websites and in beneficiary information handouts provided during enrollment.Finally, MEDCOM is establishing a methodology for accounting for all beneficiary requests for access to primary care. Knowing who is requesting care, but not given an appointment at the MTF immediately, is just as important as knowing who did receive care. This detailed accounting will enable the MTF to make appropriate adjustments in enrollment and clinic schedules. While there are many areas under current review that will enhance access to care, The Army Surgeon General and his MTF commanders are working very hard to identify all Access To Care barriers and fix them; fully realizing that some will have relatively simple solutions, while others are more complex and will require more time. These efforts will result in markedly improved access and provide MTF commanders with the tools for maintaining situational awareness so that they may make the appropriate adjustments to provide care at the MTF or give the beneficiary the choice of receiving care in TRICARE civilian network.
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