To safeguard your long-term well-being and keep our force mission-ready, this April the Coast Guard launched a new, service-wide Brain Health Initiative (BHI) to proactively monitor, treat, and track brain health injuries.
“Brain injuries don’t always occur all at once – sometimes the effects build up over time,” said RADM Charles Fosse, Deputy Commandant for Personnel (DCP). “That’s why it’s so important to pay attention when something feels off, get checked out, and stick with your treatment plan. Trying to tough it out can make things worse. Asking for help is how you protect your brain, your future health, and your ability to keep doing the things you love.”
Brain health injuries can include traumatic brain injury (TBI), blast overpressure, wave-impact injuries, and concussions. Symptoms range from headaches to amnesia (keep reading for more info).
All Coast Guard medical providers are trained to recognize and address brain health injuries. Until now, though, there hasn't been a single, standardized approach, supported by staff and resources.
The Service today released ALCOAST 280/26, which creates a proactive framework for addressing brain injuries, in order to keep members safe from hazards they may encounter during their service. All medical providers will now use the same evaluation tool – the Military Acute Concussion Evaluation 2 (MACE 2) – and the same treatment approach – the Progressive Return to Activity (PRA) protocol – to ensure all members receive the same level of care.
The new framework aligns with the Department of War’s brain health standards.
Call to Action
If you experience a head injury or see one occur at your unit (on or off duty), monitor the injured person for the common concussion symptoms – the acronym “HEADS” can help you remember the common symptoms:
Dr. Mary Vance is a board-certified psychiatrist, the Service’s Chief Mental Health Officer, and the Brain Health Initiative (BHI) Lead. She is leading the team as they develop best practices, policy, and educational materials to help make sure service members can quickly recognize and address symptoms of brain injuries.
“If you or a shipmate start experiencing any of these symptoms, please go to your Coast Guard clinic or your primary healthcare provider,” said Dr. Vance. “Although the symptoms may seem minor, your provider will need to take some specific actions to evaluate and treat for any potential brain injury. It’s important to pay attention when “something just doesn’t feel right.” You should seek immediate medical attention if you experience the following:
For more information and guidance, visit the Brain Health Initiative SharePoint. In particular, check out “What You Should Know About Concussions/Mild TBI.” (CAC Required)
New Standard of Care
When you report to medical, you can expect to receive screening through the newly implemented MACE 2. If the screening reveals that you sustained a concussion, your provider will implement the PRA protocol. As part of the treatment, you won’t return to full duty until medically cleared and appropriately recovered from your injury.
Your Coast Guard medical provider is responsible for providing final clearance for your return to unrestricted activity. Leadership and patients, the Patient and Leadership Guide will help you walk through the PRA together.
What’s Coming
The BHI is building a long-term monitoring program, coordinating health risk assessments across the fleet with the Coast Guard Safety Center (SAFECEN), and networking with partner agencies and research facilities to put the service on the cutting-edge of brain health and care.
The team is also preparing to release an updated Coast Guard Occupational Medicine Commandant Instruction, along with Tactics, Techniques, and Procedures (TTPs) that will define exactly how we implement this instruction in the field.
What Medical Personnel Need to Do Now
If you are a medical professional directly involved with patient care – including credentialed providers, registered nurses, physical therapists, and health services technicians – you have new training requirements.
By September 30, 2026, providers must complete training through the Department of War (DoW) Traumatic Brain Injury Center of Excellence (TBICoE):
The TBICoE’s website also provides key resources on acute concussion care:
Command Responsibilities
Unit commanders must actively champion the new acute concussion care protocol:
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Coast Guard clinic administrators or unit medical officers for commands without a designated administrator are responsible for tracking and ensuring their medical personnel complete the required MACE 2 and PRA training before the six-month deadline.
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Commands are also responsible for ensuring their members follow the protocols outlined by the PRA, regardless of mission impact. The Patient and Leadership Guide will help you walk through the PRA together.
Questions?
For questions regarding the BHI policy or training requirements, please contact CDR Mary Vance, Chief Mental Health Officer (CG-CMO-1) and Brain Health Initiative (BHI) Lead.
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Resources: