Page 53 - 2022 Ranger Medic Handbook

Concussion
A concussion is a blow or jolt to the head or a penetrating head injury that disrupts the function of the brain. Not all blows
or jolts to the head cause a brain injury. In combat, concussions are usually caused by a bullet, fragment, blast, fall, direct
impact, or motor vehicle crash. Some, but not all, persons with a concussion lose consciousness.
S/Sx: Headache; fatigue; sensitivity to noise and light (phonophobia and photophobia); difficulty concentrating; loss of
balance; nausea/vomiting; insomnia/sleep disturbances; vision changes/blurred vision; ringing ears; excessive tired-
ness; dizziness; drowsiness; difficulty remembering; confusion; irritability. SECTION 2

TCCC Application
Care Under Fire: Manage life-threatening hemorrhage. No specific action for TBI/concussion.
Tactical Field Care: Treat other injuries in accordance with TCCC guidelines. For patients with S/Sx of traumatic brain
injury or potential for blast injury, assess for RED FLAG symptoms, and conduct neurological evaluation.
S/Sx of RED FLAG Evacuation:
Tactical Evacuation: Evacuate based on appropriate protocol of other injuries or red flag symptoms.

Special Considerations
Mandatory events requiring MACE 2:
a. Personnel in a vehicle associated with a blast, collision, or rollover
b. Personnel within 150 meters of a blast
c. Personnel with a direct blow to the head
d. Command directed evaluation
All return-to-duty must be evaluated and approved by an MD/PA.
Concussion is primarily a clinical diagnosis. If you do not feel that a patient is back to their baseline, do not allow them
to RTD and re consult your medical provider.

Management
1. Consider concussion in anyone who is dazed, confused, “saw stars,” lost consciousness (even if just momentarily),
or has memory loss that results from a fall, explosion, motor vehicle crash, or any other event involving abrupt head
movement, a direct blow to the head, or other head injury.
2. Triage and treat other injuries as required. As soon as tactically feasible, evaluate for concussion.
3. If red flags are present – consult with medical provider for possible urgent evacuation.
4. Administer MACE 2, initiate 24-hour rest and consult with medical provider.
5. Treatment: Treat symptoms with acetaminophen, NSAIDs, and ondansetron as needed. DO NOT use narcotics or
tramadol for symptom management. Not all symptoms will respond to conservative management as the brain heals.
This is to be expected. Refer to the Ranger mTBI Return to Duty Protocol for clearance.
Extended Care
All patients with TBI/concussion injuries are to be evaluated by an MD/PA as soon as tactically feasible. If evacuation is
delayed, then remove patient from an active tactical role. If no RED FLAG indications, then place patient in a limited duty
role that will allow for rest and sleep if possible. Identify a Ranger buddy who will remain in close proximity and monitor
patient status – DO NOT allow patient to be left alone while remaining in a tactical situation. Medical personnel should
assess patient frequently for general responsiveness, vital signs, and any indication of red flag symptoms. Explain to
patient and Ranger buddy the importance of alerting medical personnel of any red flag symptoms. If possible, rest will
be the best recovery. Ensure patient remains well hydrated as dehydration will aggravate recovery. Allow patient to eat
small, light meals if not affected by nausea or vomiting. Avoid exertion and any kind of strenuous events or situations
that will hinder healing. Limit work to mundane tasks that are not critical to tactical situation but still allow a feeling of
importance.

2022 RANGER MEDIC HANDBOOK 39