Whether it be from the battlefield or the playing field, traumatic brain injury is something that has received a good deal of discussion in recent years, and along with that comes some significant breakthroughs in how is it treated, especially in a pre-hospital setting.

When it comes to emergency medical services, Arizona is becoming recognized as leading the way with innovation when it comes to pre-hospital care in the field.

The University of Arizona has established the Excellence in Prehospital Injury Care (EPIC) project with a new emphasis on traumatic brain injury.

According to the UofA, an estimated 1,000 people die each week from traumatic brain injury in the United States. It is becoming clear that the care received before arriving at the hospital can make a significant difference in life or death and even the level of recovery for survivors.

There is growing evidence that treatment in the early minutes following an injury significantly impacts the outcome of recovery.

EMTs and paramedics around the state are receiving training for a new protocol for treating TBI patients for moderate to severe injury in the field.

Fountain Hills Fire Department Paramedic Capt. Todd Brunin is certified as a master trainer with EPIC, and he has trained the Fountain Hills crews.

Fire fighters with the Rio Verde Fire District and Fort McDowell Fire Department have also received the new training.

“The training is simple,” Brunin said. “Our goal is to focus on preventing cells not already damaged from being damaged, causing secondary brain injury.”

The stated goal for the EPIC project is to “dramatically increase the number of severe TBI victims who survive with good neurological outcome by thoroughly implementing the national EMS TBI guidelines.”

The key to the treatment that preserves the healthy cells is to provide consistent and sufficient blood pressure and oxygenation to the brain, according to Brunin. Paramedics also carefully monitor the patient’s respiratory CO2 level to assure proper and effective treatment in the field.

Providing ventilation to a patient in a meticulously measured manner has brought about a modification of a common device used by medics in the field.

Just about anyone who watches television has seen emergency medical personnel using the balloon-like device to “bag” the patient.

With the standard bag it is easy in an emergency situation to over-ventilate a patient, according to Brunin.

To address the concern of over-ventilation with TBI patients, the bag has been modified to provide greater control.

It slows the amount of air going from the bag to the patient, and there is even a timing device with a signal every six seconds to tell the medic when to apply pressure to the bag.

“This is known as a ‘smart bag’ that controls the amount of pressure delivered during ventilation,” Brunin said.

This new equipment will prevent over-ventilation, which might cause damage that could lead to higher mortality rates among TBI patients, according to Brunin.

All Fountain Hills firefighters have received the training in using the “smart bag” over the past year. That training is updated quarterly and most have just completed their annual re-certification, Brunin said.

There are instances where a person may appear to have only suffered a mild head injury reporting they only loss consciousness for less than a minute. They will often tell paramedics on the scene they are OK and it’s no big deal.

“That person must be evaluated at the hospital because even a mild head injury could turn into a moderate or even a severe head injury over a short period of time,” Brunin said.

The EPIC project is a statewide collaboration between Arizona fire departments, ground and air EMS transport agencies, the University of Arizona and the Arizona Department of Health Services.

EPIC will follow up on the training received by emergency personnel with data to evaluate the long-term effectiveness of the EPIC-TBI program.