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

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.

Authors

Publication Details

Journal
Journal of Head Trauma Rehabilitation
Published
2026-10-16
DOI
https://doi.org/10.1097/htr.0000000000001221
Primary Topic
Traumatic Brain Injury Research
Type
article
Field-Weighted Citation Impact
0.00

Funders

Controls
|||
ALL TIME
JAN
FEB
MAR
APR
MAY
JUN
JUL
AUG
SEP
OCT
article

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

Nikki E. Barczak‐Scarboro, Julianne D. Schmidt, Brian Springer, Johna K. Register‐Mihalik et al.
Journal of Head Trauma Rehabilitation
Traumatic Brain Injury Research
article

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

Nikki E. Barczak‐Scarboro, Julianne D. Schmidt, Brian Springer, Johna K. Register‐Mihalik, Jacqueline M. Drew, Jacob Earl Resch, Carrie Esopenko, Behdin Nowrouzi‐Kia, Carrie W. Hoppes, Laura Boxley, Andrea L.C. Schneider, Christopher J D’Lauro, Jeffrey J. Wing, Kenneth L. Cameron, Katherine J. Hunzinger, Tracey Covassin, James A. Oñate, Andrew Sas, Jacek Kołacz, Jaclyn B. Caccese, Jill Daugherty, Michael J. Popovich, James R. Engle, Ashish R. Panchal, Joanna S. Fong-Isariyawongse, Jason M. Bailie, Elisabeth A. Wilde, Sherri Martin, David X. Cifu, Michael D. Guthrie, Thomas G. Bowman, N. K. Edwards, Anna M. August, Claire Akard, Rebeccah Wolfkiel, Thomas J. Beach, W. Huw Williams, Stephanie Samuels, Chad DePew, Patrick McKenna, Marcus Sprague, Carly Smith, Joseph Willis, Nicholas I. J. Smith, Sandy Fent Funderburgh, Sherry Nelson, Joshua Walters, Mackenzie R. Thrower, Briana Kirkland, Jennie Hill, Bryant Walrod
article en

Abstract

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.

Journal of Head Trauma Rehabilitation
Congressionally Directed Medical Research Programs
Good health and well-being
Openalex Percentile: Top 12%
Traumatic Brain Injury Research
DOIOpen Access PDFOpenAlex
AI Navigator

Ask Laika to Summarize, Analyze, and Connect papers live on the map.

Summarize Papers & Methodologies

Extract key findings, datasets, and comparative methods across publications.

Benchmark Rankings & Visual Analytics

Rank top research institutions, authors, funders, topics, and journals by Field-Weighted Citation Impact (FWCI) and paper volume with instant charts.

Connect Distant Disciplines

Bridge topological clusters on the map to find hidden collaborative intersections.