Consensus Statement on Traumatic Brain Injury in First Responders: The 1st International Conference on TBI in First Responders

@article{caccese2026consensus,
  title = {{Consensus Statement on Traumatic Brain Injury in First Responders: The 1st International Conference on TBI in First Responders}},
  author = {Jaclyn B. Caccese and James A. Oñate and Nathan Edwards and Andrew R. Sas and Nicholas I. J. Smith and W. Huw Williams and Jacob E. Resch and Carly Smith and Andrea L.C. Schneider and Katherine J. Hunzinger and Claire Akard and Anna M. August and Jason M. Bailie and Nikki E. Barczak-Scarboro and Thomas J. Beach and Laura Boxley and Thomas G. Bowman and Kenneth L. Cameron and David X. Cifu and Tracey Covassin and Jill Daugherty and Chad DePew and Christopher J. D'Lauro and Jacqueline M. Drew and James R. Engle and Carrie Esopenko and Sandy Fent Funderburgh and Joanna Fong-Isariyawongse and Michael D. Guthrie and Jennie Hill and Carrie W. Hoppes and Briana Kirkland and Jacek Kolacz and Sherri Martin and Patrick McKenna and Sherry Nelson and Behdin Nowrouzi-Kia and Ashish R. Panchal and Michael J. Popovich and Johna K. Register-Mihalik and Stephanie Samuels and Julianne D. Schmidt and Marcus Sprague and Brian L. Springer and Mackenzie R. Thrower and Bryant Walrod and Joshua Walters and Elisabeth A. Wilde and Joseph Willis and Jeffrey J. Wing and Rebeccah Wolfkiel},
  journal = {The Journal of Head Trauma Rehabilitation},
  year = {2026},
  month = oct,
  doi = {10.1097/htr.0000000000001221},
  url = {https://doi.org/10.1097/htr.0000000000001221},
  note = {CC BY-NC-ND 4.0},
}

TY  - JOUR
TI  - Consensus Statement on Traumatic Brain Injury in First Responders: The 1st International Conference on TBI in First Responders
AU  - Jaclyn B. Caccese
AU  - James A. Oñate
AU  - Nathan Edwards
AU  - Andrew R. Sas
AU  - Nicholas I. J. Smith
AU  - W. Huw Williams
AU  - Jacob E. Resch
AU  - Carly Smith
AU  - Andrea L.C. Schneider
AU  - Katherine J. Hunzinger
AU  - Claire Akard
AU  - Anna M. August
AU  - Jason M. Bailie
AU  - Nikki E. Barczak-Scarboro
AU  - Thomas J. Beach
AU  - Laura Boxley
AU  - Thomas G. Bowman
AU  - Kenneth L. Cameron
AU  - David X. Cifu
AU  - Tracey Covassin
AU  - Jill Daugherty
AU  - Chad DePew
AU  - Christopher J. D'Lauro
AU  - Jacqueline M. Drew
AU  - James R. Engle
AU  - Carrie Esopenko
AU  - Sandy Fent Funderburgh
AU  - Joanna Fong-Isariyawongse
AU  - Michael D. Guthrie
AU  - Jennie Hill
AU  - Carrie W. Hoppes
AU  - Briana Kirkland
AU  - Jacek Kolacz
AU  - Sherri Martin
AU  - Patrick McKenna
AU  - Sherry Nelson
AU  - Behdin Nowrouzi-Kia
AU  - Ashish R. Panchal
AU  - Michael J. Popovich
AU  - Johna K. Register-Mihalik
AU  - Stephanie Samuels
AU  - Julianne D. Schmidt
AU  - Marcus Sprague
AU  - Brian L. Springer
AU  - Mackenzie R. Thrower
AU  - Bryant Walrod
AU  - Joshua Walters
AU  - Elisabeth A. Wilde
AU  - Joseph Willis
AU  - Jeffrey J. Wing
AU  - Rebeccah Wolfkiel
PY  - 2026
DA  - 2026/10/16
JO  - The Journal of Head Trauma Rehabilitation
DO  - 10.1097/htr.0000000000001221
UR  - https://doi.org/10.1097/htr.0000000000001221
AB  - Objective:: To develop the first interdisciplinary consensus recommendations for the recognition, diagnosis, and management of traumatic brain injury (TBI) in first responders (ie, law enforcement/corrections officers, firefighters, emergency medical services [EMS] personnel).  Setting:: The first International Conference on TBI in First Responders, held at The Ohio State University in March 2026.  Participants:: An interdisciplinary author group of 52 clinicians, researchers, policy and organizational professionals, and first responders with lived or operational experience.  Design:: Six expert workgroups conducted a best-evidence synthesis of first responder-specific literature and relevant evidence from military personnel, athletes, and other populations. Preliminary recommendations were developed over 6 months and refined using a modified Delphi process with 2 rounds of anonymous voting via Microsoft Forms. Consensus was predefined as ≥80% agreement without reservations or with minor reservations.  Main Measures:: Evidence quality and recommendation strength were graded using the Strength of Recommendation Taxonomy (SORT). The primary outcome was the percentage of agreement for each recommendation.  Results:: Twenty-nine preliminary statements were evaluated across 6 domains: injury risk, recognition, and reporting challenges; early assessment and diagnosis; return to duty; mental health; prevention; and workplace and policy context. In round 1, 27 of 29 statements reached consensus. After group discussion, review of anonymous comments, wording refinement, and consolidation of related statements, 28 final recommendations were evaluated in round 2; all reached consensus.  Conclusion:: These recommendations provide the first interdisciplinary framework for TBI in first responders. They emphasize shared organizational responsibility, standardized terminology, nonpunitive reporting and referral pathways, clinician-guided care, occupation-specific RTD progression, mental health screening and treatment, exposure mitigation, and first responder–engaged research. Implementation of these recommendations may improve timely care, operational readiness, and the evidence base for first responders with TBI.
SN  - 0885-9701
SN  - 1550-509X
ER  -