ALCOAST 280/26 - SEP 2026 BRAIN HEALTH INITIATIVE (BHI) TREATMENT AND TRAINING REQUIREMENTS

R 092222Z SEP 26  MID120041522360U
FM COMDT COGARD WASHINGTON DC
TO ALCOAST
BT
UNCLAS
ALCOAST 280/26
SSIC 6000
SUBJ: BRAIN HEALTH INITIATIVE (BHI) TREATMENT AND TRAINING
REQUIREMENTS
A. Coast Guard Occupational Medicine, COMDTINST 6260.32
B. Coast Guard Behavioral Health, COMDTINST 6000.5
C. Comprehensive Policy on Traumatic Brain Injury-Related
Neurocognitive Assessments by the Military Services,
DoDI 6490.13, Change 2 (28 MAY 2024)
1. In APR 2026, the Commandant directed a service-wide Brain
Health Initiative (BHI) to improve how the Coast Guard prevents,
recognizes, and treats brain injuries. This ALCOAST institutes
immediate, mandatory treatment and training requirements for all
Coast Guard medical personnel. This standardized mandatory
treatment ensures a unified, high standard of care for the
prevention, recognition, and treatment of brain injuries, and is
the next step in developing and implementing the most effective
BHI among the military services.
    a. This ALCOAST also directs formal updates to REFs (A) and (B)
and related Tactics, Techniques, and Procedures (CGTTP) in
consideration of the BHI. REF (C) specifically applies to the
Coast Guard.
2. Background. The health, readiness, and long-term well-being of
Coast Guard personnel are critical to mission success. Modern
clinical research demonstrates that brain health is a fundamental
pillar of operational effectiveness.
    a. Cumulative exposure to occupational hazards; such as
hull-slamming/wave-pounding, blast overpressure, and concussive
events; poses a direct risk of acute and chronic cognitive
impairment.
    b. Proactive mitigation of these risks and the protection of
cognitive health is essential to maintaining a highly ready,
resilient, and combat-effective workforce.
3. Strategic Progress on BHI Consolidation.
    a. The Coast Guard achieved significant progress in
consolidating all decentralized existing brain health efforts
under a unified governing body.
    b. Using a holistic approach, the unified BHI is focused on
the following: learning about, protecting against, recognizing,
treating, caring for, monitoring, and documenting brain
injuries. The treatment standards and training requirements set
forth in this document are a start to actioning these focused
areas.
4. Mandatory Treatment Standards and Medical Training Requirements.
    a. All medical personnel treating brain injuries must 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."
    b. Pursuant to REF (A), all Coast Guard medical personnel
directly involved in patient care delivery must complete initial
and annual brain health training. This mandatory requirement applies
to all privileged providers, registered nurses, physical therapists,
and health services technicians. Ensuring our medical staff
maintains this training is vital to upholding our standardized
clinical care across the workforce.
    c. Required Competencies and Certification Pathways. To satisfy
clinical mandates and consistent with DoW requirements, personnel
must maintain certified competency in administering the MACE 2 and
managing patients via the PRA protocol. To fulfill both the initial
and annual requirements, personnel must submit proof of completion
for either virtual, in-person, or other self-paced instruction
as linked and described below:
        (1) Virtual Instruction. Traumatic Brain Injury Center of
Excellence (TBICoE) quarterly virtual training seminars on MACE 2
and PRA, accessible via the hyperlink:
(Copy and Paste URL Below into Browser.)

https://www.health.mil/Military-Health-Topics/Centers-of-
Excellence/Traumatic-Brain-Injury-Center-of-Excellence/TB
ICoE-Training-and-Dissemination/Acute-Concussion-Care-Pat
hway-MACE-2-and-PRA-Training

        (2) Additional live virtual training sessions hosted by
TBICoE will be made available to Coast Guard medical personnel to
rapidly meet the initial training requirement.
        (3) Self-Paced Instruction. Joint Knowledge Online (JKO)
courses on MACE 2 and PRA, accessible via the hyperlinks:
(Copy and Paste URL Below into Browser.) (CAC Required)

https://jkodirect.jten.mil

             (a) DHA-US1117-Military Acute Concussion Evaluation
Version 2 (MACE 2).
             (b) DHA-US1226-Progressive Return to Activity
(PRA) Training.
        (4) Direct Links to Standards.
             (a) Military Acute Concussion Evaluation 2 (MACE 2):
(Copy and Paste URL Below into Browser.)

https://www.health.mil/Reference-Center/Publications
/2026/02/13/Military-Acute-Concussion-Evaluation-MACE-2

             (b) Progressive Return to Activity (PRA) Protocol:
(Copy and Paste URL Below into Browser.)

https://health.mil/Reference-Center/Publications
/2024/02/23/Progressive-Return-to-Activity-Primary
-Care-for-Acute-Concussion-Management

5. Return to Duty Authorization. Final medical clearance for a
Service member's return to unrestricted operational duty remains the
exclusive authority of a credentialed, privileged provider.
6. Implementation Timeline and Command Responsibilities.
    a. All Coast Guard clinic administrators or unit medical officers
for commands without a designated administrator are responsible for
ensuring that all eligible medical personnel complete the mandated
training by 30 SEP 2026, and maintain compliance annually
thereafter. Supervisors may grant temporary extensions for
good cause.
    b. To ensure the implementation success of this directive,
unit commanders and medical leadership must actively drive
implementation, foster a command culture that destigmatizes the
reporting of head injuries, and direct any personnel exhibiting or
reporting symptoms to undergo immediate medical evaluation.
7. Strategic Next Steps and Policy Alignment.
    a. Forthcoming updates to REF (A), REF (B), and newly developed
TTPs will formalize the Coast Guard's long-term BHI strategy.
    b. Our primary efforts among these initiatives are the
integration of a permanent, longitudinal TBI Surveillance Program
within the established Occupational Medical and Evaluation Program
(OMSEP) framework; and the establishment and sustainment of a formal
BHI that is fully integrated with the Mental Health Program in order
to provide holistic care that aligns with scientific evidence
showing that mental health and brain health are closely
interconnected. More information can be found on the BHI
Sharepoint here:
(Copy and Paste URL Below into Browser.)

https://uscg.sharepoint-mil.us/sites/Brain-Health#

    c. Soon the BHI will issue guidance instructing commands on the
preparation and submission of administrative exposure letters for
TBI. These letters will serve as permanent documentation in affected
Service members' Official Military Personnel Files (OMPFs) to
capture and preserve their operational exposure history.
    d. To maximize engagement with potentially impacted Service
members, we will execute a coordinated outreach campaign leveraging
a national MyCG release, leadership Flag Voice messaging, and select
'road show' site visits, supplemented by direct briefs to the badge
network and senior leadership.
8. This message will be cancelled by 09 SEP 2027.
9. POCs. For questions regarding this policy, please contact
CDR Mary C. Vance, Chief Mental Health Officer and Brain Health
Initiative Lead, (CG-CMO-1), at Mary.C.Vance@uscg.mil; and
CDR Dara Lee, Chief, Occupational Medicine (CG-HcSC), at
Dara.Lee@uscg.mil.
10. RADM Charles E. Fosse, Deputy Commandant for Personnel
Readiness and Chief Human Capital Officer (CG-DCP), sends.
11. Internet release is authorized.