Physical Therapist Geneva Foundation, US Air Force Academy Monument, Colorado
Abstract Text:
Background: Concussions sustained during the 37 days of Basic Cadet Training (BCT) at the United States Air Force Academy (USAFA) can be problematic due to the need to expedite the trainee safely back into a highly stressful and physically demanding environment. The USAFA concussion care team has implemented multiple process improvements which have ultimately correlated with reduction in injuries and decreased lost duty time.
Methods: A retrospective review of 9 years (2014-2022) of BCT concussion data collected at the USAFA Concussion Clinic. Inclusion criteria were trainees who were diagnosed with a concussion from any mechanism during BCT. Trainees who dis-enrolled (for any reason) before completing the full care protocol were counted only in total concussion numbers, not in the full return to duty calculations.
Results: Across 10,522 trainees (2893 female, or 27.5%), there were 354 concussions reported in 347 trainees (140 females representing 40.3% of all concussed trainees, average age of all concussed trainees: 18.8 years old) during this time period. 7 trainees (6 female) were re-injured during their recoveries. The number of concussions diagnosed increased from 22 in 2014 to a high of 72 in 2018, with decreasing numbers in 2021 (13) and 2022 (16). Incidence decreased during COVID lockdown (2020) as trainees performed fewer physical activities, but recoveries experienced all-time highs (36.1 days). Over the course of 9 years, the average return to duty timeframe was 19.4 days. During 2021 and 2022, with a full return to usual basic training activities, there was less incidence (13 and 16 concussions) and quicker recoveries (19.0 and 11.9 days).
Discussion: Awareness of concussion, willingness to seek treatment and standardization of diagnosis most likely contributed to initial increases in concussion incidence from 2014 to 2018. COVID lockdowns in 2020 changed training dramatically, so incidence of injury decreased from prior years; however, despite lower numbers, recovery time increased due to quarantining and changes in concussion management during the pandemic – this year can be considered an anomaly. Over the 9-year period, our staff made many changes to the concussion care system at USAFA, to include improvements in concussion management, mass education, a culture of awareness and recognition, surveillance and feedback to commanders. Specifically, these include standardizing all concussion care for trainees with a single point of care and specific protocols, provider education, baseline concussion evaluations, patient tracking with rigorous follow up, multiple awareness briefings to BCT leadership and trainees, a ‘concussion flight’ (quiet dormitories for recovery), injury surveillance with timely feedback to leadership, and a modified return to training (academics and physical training) protocol for basic training.
Conclusion: With the establishment of a concussion clinic and greater awareness of the injury, we found a large increase in the overall number of concussions reported and diagnosed initially, with decreasing numbers in subsequent years. Additionally, return to duty time has trended in a positive direction, with trainees recovering quicker. COVID lockdowns presented challenges for concussion care in 2020. Over the study period, we suspect our concussion care changes and USAFA’s commitment to a safe training environment have benefited trainees by reducing concussion incidence during military training and trending towards improved return to duty times.
Keywords: concussion, military training, process improvement, incidence, return to duty
