About the Acute Effects of Neurotrauma Consortium
America's warriors, regardless of the uniform, are subjected to the potential for concussive injuries throughout their careers in the military. Exposure to head injuries begins in Basic Training. If there is a potential opportunity to prevent, identify and better treat this group of Americans why wouldn't decisive action be taken?
In the medical community, there exists an extensive body of research and knowledge in Traumatic Brain Injuries (TBI's) more commonly referred to as concussions. This knowledge is overwhelmingly based on Chronic TBI's, in that the damage has occurred and must be treated accordingly on a long term basis, however, there is very little research and understanding of "Acute" TBI's, i.e. the concussive event just happened. Essentially, there is little research on how to prevent, identify and treat concussive events in the acute phase. Further, based on the results of these three research areas, training of soldiers and athletes may be revised.
At Army TRADOC installations, such as Fort Leonard Wood, as civilian's transition into soldiers during Initial Entry Training (IET), followed by Advanced Individual Training (AIT) the physicality of the training often results in injuries to the Trainee's. It is estimated there are between 400 and 600 TBI's occurring annually, from training such as the Confidence Course, the Grenade Range, the Vehicle Rollover Simulators, Pugil Stick training and surprisingly, the barracks areas. (Many Trainees have never slept in a narrow bunk bed before.) Further, in the more advanced training such as the Military Police Take-Down training, and the Breacher Training, TBI's are utterly predictable.
On 1 April 2016 the General Leonard Wood Community Hospital (GLWACH) hosted a TBI Summit meeting, inviting various universities to learn about the number of TBI's occurring at the Installation. The Summit was attended by 4 Universities around the state with a surprising degree of interest in conducting TBI research. The major focus resulting from the Summit being the forms of governance to allow for research on Post.
In order to accomplish this solution, several documents/agreements and entities needed to fall into place. The sequence being:
- Resolve the governance of how to perform research work on Post.
- Gain the support of the Maneuver Support Center of Excellence (MSCoE) to support Research which does not interfere with training.
- Standup the entity to funnel research from the Universities to the Post.
- Engage with the Universities, with the desire to pursue research funding.
- Engage with the funding entities (DoD, DA, DAF, ONR, NIH, HHS, etc.) to launch topics pursuant to acute TBI research.
The Acute Effects of Neurotrauma Consortium has been formed with actions as follows.
The U.S. Army Medical Research and Materiel Command (MRMC) has a strong relationship with the Chronic Effects of Neurotrauma Consortium (CENC) which is a coordinated, multicenter collaboration linking basic science, translational and clinical neuroscience researchers from the VA, military and academia to effectively address the long-term effects of mild Traumatic Brain Injuries (mTBI) and its diagnosis and treatment. Based on the successes of this model, while working closely with MRMC, the Phelps County Regional Medical Center (PCRMC) and the Leonard Wood Institute (LWI) formed the AENC. The vision of the AENC is nearly identical to the CENC, except the focus is on the Acute aspect of mTBI's. The main difference being that the AENC was funded without Appropriated monies.
MRMC coordinates outreach research via its Master Cooperative Research and Development Agreement (CRADA). This document is sufficiently broad enough to allow for research that involves people, as well as patients. In the people role, items such as protective gear are covered, while patients are covered via HiPPA rules and a medical Institutional Review Board (IRB). Accordingly, the partnership of LWI covers the people protection and processes types of research while PCRMC's involvement covers the patient and medical types of research. CRADA # MC-17-0131 between MRMC, LWI and PCRMC was fully executed on 2/6/2017. The GLWACH serves as the local representative for MRMC in the CRADA.
Because the GLWACH is a tenant organization on Ft. Leonard Wood, another agreement was required, in order to make the connection with the Training Brigades on Post. A Memorandum of Understanding was executed between the Maneuver Support Center of Excellence, including the Garrison Command, the GLWACH and PCRMC.
A Membership Agreement has been developed and was signed by four Universities that attended the April 12, 2017 AENC Concussion Conclave. Those Universities, the University of Missouri School of Health Professionals, UMKC, Missouri S&T, and Washington University are the founding members of the AENC. Other research universities and possibly private entities are invited to join.