Traumatic Brain Injury in First Responders: From Hidden Burden to Occupational Health Action.

Traumatic brain injury (TBI), including concussion, is an important but often underrecognized occupational injury among first responders. Despite frequent exposure to circumstances that increase the risk of TBI, law enforcement officers, firefighters, and emergency medical services personnel often lack consistent pathways for injury recognition, reporting, clinical assessment, rehabilitation, and safe return to duty. This topical issue of the Journal of Head Trauma Rehabilitation brings together emerging evidence on TBI prevalence, underrecognition, mental health, functional recovery, and occupational reintegration in first responder populations. Collectively, the articles demonstrate a substantial burden of TBI, persistent gaps in diagnosis and treatment, and the complex relationships among TBI history, psychological health, and occupational functioning. They also highlight the limited evidence available to guide rehabilitation and determine readiness to resume safety-sensitive duties. A multidisciplinary consensus statement included in this issue offers 28 recommendations addressing recognition and reporting, early assessment, return to duty, mental health, prevention, and organizational policies. Although first responder-specific evidence remains limited, these recommendations provide a practical framework for improving care while identifying priorities for future research. Advancing TBI care in first responders will require coordinated efforts among healthcare professionals, first responder organizations, researchers, and policymakers to establish supportive reporting systems, improve access to appropriate care, and develop and evaluate occupation-specific return-to-duty pathways. Addressing TBI in first responders requires moving beyond individual injury management toward a coordinated occupational health approach that protects first responders and the communities they serve.