USU Tackles Battlefield Brain Injuries with Future-Focused Solutions
Experts at the Uniformed Services University are pioneering technologies and training to ensure service members with traumatic brain injuries can be treated on the future battlefield.
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MTBI2, led by U.S. Army Lt. Col. (Dr.) Bradley Dengler, is focused on minimizing the impact of traumatic brain injuries on service members. (Photo courtesy of Bradley Dengler) |
July 1, 2025 by Vivian Mason
Traumatic brain injuries (TBIs) are among the most complex medical challenges faced on the battlefield. At the Uniformed Services University (USU), researchers are working to improve how TBIs are assessed and managed in operational environments through the Military Traumatic Brain Injury Initiative (MTBI2).
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Lt. Col. (Dr.) Bradley Dengler (Photo credit: Tom Balfour, USU) |
“The shortage of neurosurgeons will directly impact the treatment of traumatic brain injuries, particularly intracranial mass lesions requiring neurosurgical evacuation,” Dengler said. “So, what this translates to is that in the next near-peer conflict... we're not going to be able to transport injured service members back quickly. So, we have to come up with other ways to save lives that don't involve getting patients to a neurosurgeon.”
The solution, according to Dengler, involves researching and developing new tools and training non-specialists to diagnose and treat life-threatening brain hemorrhages.
Advancing Diagnostics at the Point of Injury
A key step forward is a rapid blood test for TBI, recently cleared by the U.S. Food and Drug Administration. Dengler calls it “one of the most significant steps forward in the care of TBI patients in the past 20 years.”
- The test runs on a portable device and can determine if a person’s blood contains protein markers for a mild TBI in just 15 minutes.
- It can be used up to 24 hours after an injury, a significant improvement over previous tests.
- Evidence suggests a future version could also triage more severe injuries, as biomarker levels correlate with the severity of intracranial damage, helping to get the most critical patients to neurosurgical intervention faster.
“Given the large numbers of expected casualties with all severities of traumatic brain injury in future, large-scale combat operations, this blood test can help maintain combat power far forward by helping to eliminate unnecessary evacuations,” Dengler said.
Other diagnostic tools being explored include:
- Pupillometry: An ongoing study at the U.S. Military Academy at West Point with more than 2,000 cadets has demonstrated significant changes in eye pupil dynamics after a concussion. This technology provides a rapid screening tool that can also help predict recovery time, informing evacuation decisions on the battlefield.
- Sensor-Integrated Mouthguards: To improve early detection of head injuries in airborne personnel, mouthguards with integrated sensors are being explored to monitor impact forces. Data shows a correlation with blood biomarkers for brain injury, allowing medics or corpsmen to quickly identify personnel who need medical attention.
New Tools and Training for Treatment
Research is also focused on developing tools and techniques that general surgeons and even medics or corpsmen can use if there are limited neurosurgical capabilities.
Dengler is working with Dr. David Brody, a professor of Neurology and chief science officer for MTBI2 at USU, and the Johns Hopkins University Applied Physics Lab. Their team is developing optical imaging that uses near-infrared technology to diagnose the size and location of a hemorrhage. As part of this project, they are also developing a special burr hole device that can lock into the skull. This would allow a non-neurosurgeon to drill a sealed, sterile hole to remove some blood, stabilizing the patient until they can reach a neurosurgeon.
“It’s difficult to remove an entire blood clot through a small burr hole, but some blood can be removed that can decrease intracranial pressure,” Dengler explained. This temporizing measure is easier to teach than a full craniotomy and can be a life-saving intervention.
Establishing a Standard of Care
Comprehensive guidelines are essential for standardizing TBI care in combat environments. The Guidelines for the Management of Penetrating Traumatic Brain Injury and the Guidelines for the Management of TBI in Combat and Austere Environments are vital resources for improving treatment and outcomes. Dengler and his team are also working with the Brain Trauma Foundation to update the fifth edition of the Guidelines for the Management of Severe Traumatic Brain Injury. These tools, along with the provider tools available for mild TBI, help providers deliver evidence-based diagnosis and treatment across the full spectrum of TBI severity.
“Improving battlefield care in anticipation of future conflicts will require a multifaceted approach that integrates advanced training, innovative technologies, and adaptive strategies, to include telemedicine and autonomous medical systems to ensure the readiness and effectiveness of our battlefield medical system,” Dengler acknowledged. “I’m excited to be a part of it.”
