Using the Joint Trauma System, Clinical Practice Guideline titled Use of TBI Biomarkers After a Potentially Concussive Event, here is a detailed list of medical materiel needed to implement this guideline, assuming care at Role of Care 1–3 levels where biomarker use is feasible.
1. Biomarker Testing Equipment & Supplies
These enable objective assessment of brain injury severity via blood-based biomarkers (e.g., GFAP and UCH-L1).
A. Biomarker Platform (Abbott i-STAT TBI Whole Blood test)
- FDA-cleared TBI biomarker system (analyzer device)
- Test cartridges specific for GFAP and UCH-L1
- External control/test calibration kits (if applicable)
- Maintenance kit for analyzer (cleaning solutions, swabs)
- Device software update instructions
- Accessing device software and update procedures are located in section 1 and Appendix D of the ATBI Technical Manual, TM 8-6630-261-12&P accessed on the Army Publishing Directorate here: https://armypubs.army.mil.
B. Blood Collection Supplies
- Venipuncture supplies:
- Tourniquets
- Alcohol/iodine prep pads
- Vacutainer tubes (EDTA or heparin, depending on platform)
- Butterfly needles or standard needles
- Collection tube holders
- Bandages or gauze + tape
- Biohazard disposal container (sharps)
- Cold chain storage
2. Neurological & Cognitive Assessment Tools
Used for screening, documentation, and clinical decision-making alongside biomarkers.
- MACE 2 (Military Acute Concussion Evaluation Version 2) cards or digital tool
- Neurologic exam checklist or reference card
- Glasgow Coma Scale (GCS) reference card
- Pupillary light reflex pen (penlight)
- Stopwatch or timer
- Blood pressure cuff & stethoscope (for baseline vitals)
- Pulse oximeter
- Thermometer (to rule out confounding febrile causes)
- Basic neurologic exam kit:
- Reflex hammer
- Tuning fork
- Visual acuity chart
3. Documentation & Reporting Tools
Ensure proper capture of data for medical and operational purposes.
- DD Form 1380 Tactical Combat Casualty Care Card
- Electronic Health Record (EHR) system if applicable
- Printed or digital algorithm from the CPG
- Biomarker test logbook or quality control record
- Patient information leaflets on TBI/concussion (if available)
4. Storage, Packaging & Transport
Supports safe and effective use in deployed settings.
- Ruggedized carrying case for biomarker device
- Refrigeration/cooler for samples, TBI Whole Blood Cartridges, Control Level 1 and 2, and Calibration/Verification Cartridges
- Power adapters for POC analyzer
5. Additional Medical Supplies
- Personal Protective Equipment (PPE): gloves, masks, goggles
- Disinfectants for cleaning equipment
- Eye protection (if working in austere environments)
- Hand sanitizer and cleaning wipes
References for Use
- JTS CPG: Use of TBI Biomarkers After a Potentially Concussive Event (latest edition)
- ATBI Technical Manual TM 8-6630-261-12&P (Accessed on the Army Publishing Directorate at https://armypubs.army.mil)
- DoD Quick Reference Guide and Troubleshooting Procedures (Included in the Deployment Kit and Appendix F of the ATBI Technical Manual)
- DHA Procedural Instructions for neurotrauma/TBI documentation
- MACE-2 & ACE (Acute Concussion Evaluation) instructions
For additional information refer to:
DISCLAIMER: This is not an exhaustive list. These are items identified to be important for the care of combat casualties.