Since the start of the United States’ armed engagement in Iraq and Afghanistan, many military members have fallen victim to Improvised Explosive Devices (IEDs) and other explosive blasts. As most people know, IEDs have been a major contributing factor to the death toll of Americans in the Middle East. A lot of servicemembers have survived these blasts with visible injuries and others have walked away unscathed, or so they thought.

According to the Defense and Veterans Brain Injury Center, in 2017 it was reported that approximately 350,000 military personnel had experienced a traumatic brain injury (TBI) since 2000. It was estimated that anywhere from 11 to 23 percent of deployed personnel had been exposed to a TBI event. There is such a wide range in the estimate because many individuals either didn’t report their injuries or didn’t realize they had experienced a TBI at the time they were exposed to a blast.

It was estimated that approximately 50 percent of the individuals who experienced a TBI also exhibited Posttraumatic Stress Disorder (PTSD). Before the true dangers and repercussions of TBIs were understood, many operators claimed they would experience concussive blasts while outside the wire, or on a mission, to only go out the next night and operate all over again.


Treating Brain Injuries 

When I arrived at the Special Operations Combat Medic Course (SOCM) in 2012, the severity and dangers of TBIs had become fully understood. Dealing with and treating TBIs was at the forefront of the special operations medical community and was implemented into the SOCM training curriculum.

The critical piece to understanding and treating a TBI is to identify when a TBI event occurs. It had been discovered that if an operator did experience a TBI, they would be much more susceptible to serious brain damage if they were exposed to a secondary TBI or a concussive event soon after. The SOCM schoolhouse understood this and began training medics on how to properly conduct a Military Acute Concussion Evaluation, better known as a MACE exam.

Brain Injury reconditioning army military
A soldier suffering from Traumatic Brain Injury (TBI) undergoes reconditioning through exercise. (Photo by Master Sgt. Ben Navratil/U.S. Army)

During a MACE exam, the medic asks the patient a variety of questions and conducts different tests to determine the cognitive function of the patient’s brain. The MACE exam assists medics and medical professionals in determining if an individual experienced a TBI and what is its severity level.

Conducting a MACE exam provides multiple benefits for the patient. First and foremost, by conducting a MACE exam, medical providers can definitively determine if an individual experienced a TBI and thus prevent him from re-entering a dangerous environment until he is completely healed and considered fit for duty. Secondly, if an operator experiences a TBI and the event is documented by the use of a MACE exam, the operator will be entitled to disability compensation benefits and other resources to help heal and manage this “invisible” injury.

A SEAL medic who recently attended the mandatory, two-year SOCM Refresher Course, claimed that the special operations medical community is placing more emphasis on TBIs now than ever before. This is supported by the amount of training that is taking place at the SOCM schoolhouse and the implementation of the MACE 2 exam. The MACE 2 exam became available in 2018. This updated exam provides improved brain injury information, testing, and vestibular-ocular-motor screening.

The United States military has made great achievements in identifying and treating individuals who have experienced TBIs. The research, treatment, and preventative care today will help keep our warriors strong tomorrow.


This article was originally published in January 2020. It has been edited for republication.