In the high-stakes world of modern combat, where every second counts and the fog of war can obscure even life-threatening injuries, the US military is seeking a faster, more reliable way to assess head injuries.

To meet this need, the Brain Trauma Foundation (BTF) and the Military Traumatic Brain Injury Initiative (MTBI2) have joined forces to create cutting-edge clinical guidelines that could help determine a soldier’s readiness to return to battle in just 90 seconds. Leading this ambitious effort is Dr. Gregory Hawryluk, a neurosurgeon at the Cleveland Clinic and the medical director of BTF. He shared the vision, progress, and potential of the initiative in an interview with Drug and Device World.

A Legacy of Impact and Innovation

The BTF was established in 1986 and has since become a pioneering force in evidence-based guidelines for treating traumatic brain injury (TBI). “The Foundation actually grew out of the Sunny von Bülow case, which was the subject of the film Reversal of Fortune,” Dr. Hawryluk explained. “Initially, it funded grants and did policy work, but in the 1990s, as evidence-based medicine gained momentum, the organization turned toward clinical guidelines.”

BTF made history by publishing the first-ever clinical practice guidelines in any surgical specialty in 1996. Over time, these guidelines have demonstrated remarkable effectiveness. “For our adult coma guidelines, we’ve repeatedly seen a 50% reduction in mortality when they’re followed,” said Dr. Hawryluk. “Another study on our pre-hospital guidelines showed that in the sickest patients, following our protocol tripled the chances of surviving to the hospital.”

With such a proven track record, it was only natural that the military—facing unique and urgent challenges related to head injuries—would partner with BTF to modernize TBI response in combat scenarios.

Why the Military Needs Faster Tools

TBI has emerged as one of the most common wounds in modern warfare. Body armor, while lifesaving, can redirect blast waves toward the head, increasing the risk of cerebral damage. Dr. Hawryluk noted, “It’s said body armor can function like a plunger—when a blast wave hits, it can squish blood up into the brain, rupturing vessels.”

The existing tool for field evaluation, the Military Acute Concussion Evaluation (MACE), takes 10 to 30 minutes to administer—an impractical timeline in emergency scenarios. “One veteran shared his experience from when Iran fired rockets at US bases in Iraq,” Dr. Hawryluk recounted. “They had to evaluate over a thousand soldiers. With MACE, it would have taken days.”

To address this, the military tasked BTF and MTBI2 with developing what they’re calling a rapid readiness screen: a quick, reliable, and adaptable screening tool to determine whether a soldier can return to duty immediately after a suspected concussion.

The 90-Second Vision

The envisioned screening test is modeled after the Glasgow Coma Scale, which evaluates eye, motor, and verbal responses—simple yet powerful indicators of neurological function. “We’re keeping those same three categories, but developing more rapid and refined testing within each,” said Dr. Hawryluk. “Some elements could even be self-administered, depending on the situation.”

Importantly, the team aims for this new tool to be adaptive—able to operate in various environments with or without advanced equipment. “In battlefield conditions, you often don’t have a CT scanner or specialist. You might have a medic with a backpack under fire,” Dr. Hawryluk emphasized. “Whatever we design has to fit within that reality.”

The current direction involves building an app-based solution in collaboration with MIT Lincoln Laboratory. “This would allow an adaptive decision tree based on the user’s environment. If you’re in a fully-equipped facility, the tool might guide you one way; in combat, it takes a leaner route.”

Dr. Hawryluk offered a pop culture analogy: “In Blade Runner 2049, there is a scene where the protagonist goes into a room and undergoes a fast, automated psychological test—interlinked, baseline testing—that’s kind of the idea here.” The test wouldn’t just determine cognitive status but also readiness to perform the duties of a soldier.

The implications stretch beyond military use. “We realized the potential applications are huge,” said Dr. Hawryluk. “Think of truck drivers, emergency responders, or physicians on call for 36 hours. Fatigue, intoxication, or sleep deprivation can impair judgment just like a concussion.” The National Highway Traffic Safety Administration (NHTSA) has already expressed interest in collaborating, with a possible application in roadside sobriety checks.

Designing for Simplicity and Accuracy

Creating a 90-second screening tool isn’t just about speed—it’s also about accuracy and adaptability. “The performance metrics—sensitivity, specificity, predictive value—are front and center in our work,” said Dr. Hawryluk. “We’re selecting tests that work well even when administered by non-specialists in high-stress conditions.”

The design must balance inclusivity and efficiency. “We’re toying with the idea of different thresholds for different contexts,” he explained. “Mass casualty scenarios might demand high sensitivity, while hospital settings may allow for more specificity.”

And because even medical professionals could be among the injured, automation and objectivity become crucial. “If the medic or doctor is themselves concussed, you need a system that doesn’t rely solely on human judgment,” said Dr. Hawryluk.

To make sure the tool is practical, the development team included military medics—those with firsthand knowledge of battlefield triage. “They’re the ones who know what works and what doesn’t. Their feedback has been essential,” he noted. “Size, weight, disposables—these things matter immensely in a medic’s kit.”

A follow-up project is now underway, funded through a second military grant, to evaluate and integrate the chosen test components into a functional prototype.

Beyond Evidence Alone: The Role of Expert Opinion

While BTF has always prided itself on scientific rigor, Dr. Hawryluk acknowledged that the field of TBI suffers from limited data. “The bar for evidence has risen, but the science in head injury hasn’t kept pace,” he explained. “So we’ve reintroduced carefully curated expert opinion into our guideline process—clearly labeled, transparently developed.”

To increase adoption, BTF has launched educational initiatives with the American College of Surgeons and is actively working to promote broader guideline awareness and compliance. “Our guidelines save lives. Now we need to get more people to use them,” said Dr. Hawryluk.

The rapid readiness screen initiative is still in development, but its promise is unmistakable. What started as a military solution may well transform TBI assessment across many domains. With simplicity, adaptability, and real-world relevance at its core, this innovation could one day become standard in ambulances, sports fields, roadside checks—and yes, on the battlefield.

“Ultimately, we’re building a tool for readiness—military or otherwise,” Dr. Hawryluk concluded. “If we can deliver fast, evidence-based, and usable guidance, we’ll change outcomes for the better, wherever head injuries occur.”