Army Sgt. Michael Anthony Mynard talks with his nurse-case manager 1st Lt. Laurie Voss at a warrior clinic. (U.S. Army photo by Kayla Overton)

It hardly seems possible that I have been a case manager for 15 years and a nurse for longer. Someone once asked me, shortly after I left the emergency room to begin case management, if I were still a “real nurse.” I can’t repeat my initial reply here, but I did end up publishing an article in the magazine “Nursing Spectrum” that hopefully set the record straight. While I no longer do clinical nursing, I still use those essential skills as a case manager. I often also find myself having to be a disease specialist, social worker, counselor, transportation agent, negotiator, as well as insurance savvy.

It’s a whirlwind of 10- to 12-hour days for case managers to meet the needs of patients, physicians, family members, line commanders, lawyers and employers, but last week I was able to participate in a very informative webinar. The September DCoE webinar, “Case Management of Mild Traumatic Brain Injury,” highlighted the role of case managers and what it means to manage service members who’ve sustained a mild traumatic brain injury (TBI). I never thought my life path would give me an opportunity to serve the military, but I’m fortunate that it has.

Since the beginning of the conflicts overseas, as of second quarter 2011, more than 220,000 service members sustained a TBI and of this number, more than 169,000 had a concussion, or mild TBI. For about 10 to 15 percent of these service members, the post-concussive symptoms related to mild TBI are anything but “mild.” Regardless of how the injury occurred, or where, service members who don’t experience initial symptom resolution within a few days to weeks will most likely require further assessment and treatment by a multidisciplinary team. With the help of case managers, service members and their families are set up with a myriad of specialists, tests, treatments, rehabilitation plans and re-assessments necessary to treat an individual with persistent post-concussive symptoms.

At the webinar, I presented a brief look at some of the information contained in the Case Management for Concussion/Mild TBI Guidance Document, VA/DoD Clinical Practice Guideline for Concussion/mild TBI as well as new case management resources. Case management is based on nationally-recognized processes: assessment; planning; implementation and coordination; communication; advocacy; and monitoring, which can be applied to virtually any patient population. This ensures transitions of care are seamless and the treatment plan is comprehensive for the service member.

Presenter Lisa Perla, national polytrauma coordinator with the Department of Veterans Affairs, described the vast, comprehensive resources available to both active-duty service members and veterans through the VA Polytrauma System of Care. Presenter Jennifer Audette, Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn program manager with the Albany VA Medical Center, discussed basic case management principles and case management differences between the Departments of Defense and Veterans Affairs.

Understanding what clinical, social and informational resources are available for the military TBI population can be challenging, and DCoE actively produces tools for case managers and other providers to meet this need. I encourage you to check out DCoE’s Information Sheet “About TBI,” and subscribe to DCoE’s “Military TBI Case Management” quarterly newsletter, for informative articles, continuing education information and relevant updates.

For more information on case management of mild TBI, check out audio and slides from this webinar on the DCoE website, and also download the Military TBI Case Management National Resource Fact Sheet.