Consensus Statement on Traumatic Brain Injury in First Responders: The 1st International Conference on TBI in First Responders

Abstract

Objective: To develop the first interdisciplinary consensus recommendations for the recognition, diagnosis, and management of traumatic brain injury (TBI) in first responders (ie, law enforcement/corrections officers, firefighters, emergency medical services [EMS] personnel). Setting: The first International Conference on TBI in First Responders, held at The Ohio State University in March 2026. Participants: An interdisciplinary author group of 52 clinicians, researchers, policy and organizational professionals, and first responders with lived or operational experience. Design: Six expert workgroups conducted a best-evidence synthesis of first responder-specific literature and relevant evidence from military personnel, athletes, and other populations. Preliminary recommendations were developed over 6 months and refined using a modified Delphi process with 2 rounds of anonymous voting via Microsoft Forms. Consensus was predefined as ≥80% agreement without reservations or with minor reservations. Main Measures: Evidence quality and recommendation strength were graded using the Strength of Recommendation Taxonomy (SORT). The primary outcome was the percentage of agreement for each recommendation. Results: Twenty-nine preliminary statements were evaluated across 6 domains: injury risk, recognition, and reporting challenges; early assessment and diagnosis; return to duty; mental health; prevention; and workplace and policy context. In round 1, 27 of 29 statements reached consensus. After group discussion, review of anonymous comments, wording refinement, and consolidation of related statements, 28 final recommendations were evaluated in round 2; all reached consensus. Conclusion: These recommendations provide the first interdisciplinary framework for TBI in first responders. They emphasize shared organizational responsibility, standardized terminology, nonpunitive reporting and referral pathways, clinician-guided care, occupation-specific RTD progression, mental health screening and treatment, exposure mitigation, and first responder–engaged research. Implementation of these recommendations may improve timely care, operational readiness, and the evidence base for first responders with TBI.