John B. Holcomb, M.D., F.A.C.S; UTHealth/Memorial Hermann, Traumatic Brain Injury Multidisciplinary Research Consortium Award

I started getting interested in military trauma when I signed up for my Health Profession Scholarship Program in 1981. And I went to medical school on a scholarship from the Army and then came on Active Duty in the Army in 1985.

I deployed six times to Iraq and once to Somalia and saw a lot of head injury patients, both mild, moderate, and severe, blunt, and penetrating. It's a very common injury on the battlefield. It's especially worrisome when you combine that with other injuries so you know one by itself is bad enough. You start layering in the other injuries be they orthopedic injuries, which is very common to extremities, and so from a research point of view and from a patient care point of view, I've had a heavy trauma emphasis throughout my whole life in the military. Ended up retiring 2 years ago after 23 years on Active Duty, and then had the great fortune to come back to Houston and work both at Herman, a Level One Trauma Center and for UT at the University and we work combined together in a collaborative fashion taking care of a lot of trauma patients. We're the biggest trauma center in the United States.

And while we don't want people to get hurt, if you want to do trauma research you have to have a volume-large volume of patients.

So there's great opportunities to do great research; there's a lot of people that are dedicated to trauma here. There's a big trauma history with Dr. Red Duke; he's been here for 35 years. So it's a great place to continue my interests in trauma-patient care and trauma research.

Mild TBI has been around a long time. Look at the football players; it's a big deal right now. In fact, the NFL just came out with some new guidelines on head injury over the last couple days, recognizing the long-term effects of repeated concussions. We're in another war; it's the biggest war we've been in a generation and since the last time we had a big war in Vietnam that went on for an extended period of time and generated a large number of casualties, diagnostic techniques have improved, mental care has improved, and we're just more aware of concussions.

The TBI Consortium centered here in Houston is really a unique animal. There's a lot of different universities and a lot of different investigators that have come together and focused their efforts at basic science and in clinical science and diagnostic areas on this question. The days of one guy having a really good idea and then driving that all the way home and to clinical practice are probably long gone. You have to have the right nurses, the right PhD, the right MDs, all-everybody all working together in the right physical location, the right communication abilities to make advances in medicine rapidly.

And of course, the goal is to understand at a molecular level and at a whole organ animal level and imaging level and in a clinical level with a clinical study what causes mild TBI, how best to study it, what are the best models, and what are the best interventions. It's a pretty unique focus that I don't think has really happened before.

I spend most of my time on the clinical project. We're recruiting patients in the Emergency Department with Dr. Jamie McCarthy who helps run that effort down here. It's a combined effort with our Emergency Department and one over at Ben Taube which is across the street where we're trying to recruit mild TBI patients with isolated mild TBI and not a lot of other injuries and then in a prospective randomized fashion to see if we can improve their outcome.

We have made some changes to the protocol in the last year with understanding the effects of alcohol. There's a lot of alcohol and drugs in this population we care for and obviously we don't want to do neuro-psychiatric testing, very sophisticated testing and have them-the results influenced by drugs and alcohol. So we've taken steps to mitigate that aspect to increase the recruitment and then get the patient sent to a clinical research center and then studied and out the door.

This program that's run out of MRMC at Fort Detrick is a little bit more specific toward what the issues are for the deployed soldiers, you know and that is what is unique I think about the program as opposed to many other funding agencies.