MACE Return-to-Duty & Recovery Protocols 2 — Questions and Answers
Question 1: What factors indicate a service member may need referral to a TBI specialist?
- Symptoms persisting beyond 7-14 days, worsening symptoms, history of multiple concussions, abnormal neurological findings, or significant functional impairment (Correct answer)
- All concussions require specialist referral
- No concussions require specialist referral
- Only loss of consciousness requires referral
Correct answer: Symptoms persisting beyond 7-14 days, worsening symptoms, history of multiple concussions, abnormal neurological findings, or significant functional impairment
Referral criteria include: symptoms not resolving within expected timeframes, worsening trajectory, multiple prior concussions, abnormal imaging or neurological exam, pre-existing mental health conditions complicating recovery, or significant duty impairment.
Question 2: What cognitive rehabilitation strategies are used for concussion recovery?
- Graduated cognitive loading, compensatory strategy training, attention and memory exercises, and psychoeducation about expected recovery (Correct answer)
- No cognitive rehabilitation exists for concussion
- Only medication is used
- Cognitive rehabilitation is only for severe TBI
Correct answer: Graduated cognitive loading, compensatory strategy training, attention and memory exercises, and psychoeducation about expected recovery
Cognitive rehabilitation may include progressive cognitive loading (reading, problem-solving), compensatory strategies (note-taking, checklists), targeted attention/memory training, and education about normal recovery expectations.
Question 3: How should a medic or corpsman manage a concussed service member in a combat environment?
- Conduct MACE assessment, ensure safety from further injury, monitor for red flag symptoms, evacuate if indicated, and document all findings (Correct answer)
- Ignore the concussion and continue the mission
- Administer pain medication and return to duty
- Only evacuate for loss of consciousness
Correct answer: Conduct MACE assessment, ensure safety from further injury, monitor for red flag symptoms, evacuate if indicated, and document all findings
Combat concussion management requires balancing tactical needs with medical care: conducting rapid assessment, ensuring the service member is in a safe location, monitoring for deterioration, making evacuation decisions, and documenting everything.
Question 4: What is the significance of previous concussion history in managing new concussions?
- Prior concussions increase vulnerability to subsequent injury, prolong recovery times, and lower the threshold for symptom development (Correct answer)
- Previous concussions have no effect on new injuries
- Multiple concussions actually make the brain more resilient
- History is only relevant for athletes, not military
Correct answer: Prior concussions increase vulnerability to subsequent injury, prolong recovery times, and lower the threshold for symptom development
Research shows that service members with concussion history are more susceptible to subsequent concussions, experience longer recovery periods, and may develop persistent symptoms at lower injury thresholds, requiring more conservative management.
Question 5: What documentation is required throughout the concussion recovery process?
- Initial MACE scores, serial symptom checklists, follow-up MACE scores, activity progression notes, and final return-to-duty clearance documentation (Correct answer)
- Only the initial assessment needs documentation
- Documentation is optional during recovery
- Only the final clearance needs to be documented
Correct answer: Initial MACE scores, serial symptom checklists, follow-up MACE scores, activity progression notes, and final return-to-duty clearance documentation
Comprehensive documentation tracks the entire recovery: initial assessment, serial symptom monitoring, repeat cognitive testing, progressive activity tolerance, and final clearance. This record supports medical decisions and disability claims if needed.
Question 6: What role does sleep play in concussion recovery protocols?
- Adequate, quality sleep is essential for brain healing and is actively managed through sleep hygiene education and environmental modifications (Correct answer)
- Sleep should be limited after concussion
- Sleep has no impact on recovery
- Service members should sleep as little as possible to stay alert
Correct answer: Adequate, quality sleep is essential for brain healing and is actively managed through sleep hygiene education and environmental modifications
Sleep is critical for brain recovery after concussion. Protocols emphasize sleep hygiene education, consistent sleep schedules, dark/quiet environments, limiting caffeine and screen time, and addressing sleep disturbances medically if needed.
MACE Return-to-Duty & Recovery Protocols 2
What factors indicate a service member may need referral to a TBI specialist?