Blog Post

First Responders Face Hidden Brain Injury Risks, Penn LDI Review Finds

Police, Firefighters, and EMTs Suffer More Injuries and Face Care Gaps, LDI Fellow Says

September 2, 2026

By:

Karl Stark

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The latest revelation that San Francisco Hall of Fame running back Roger Craig has dementia, potentially stemming from his playing days, underscores a simple fact: We know an increasing amount about traumatic brain injuries (TBIs), also known as concussions or head injuries, in football players, thanks to two decades of such discoveries.

But LDI Senior Fellow Andrea Schneider now has helped expand concerns about TBIs to a new group: first responders.

Police may face a 60% to 70% lifetime risk of sustaining a TBI, said Schneider, an Associate Professor of Neurology at the University of Pennsylvania, citing published research. Firefighters and Emergency Medical Technicians (EMTs) also seem to face higher risks, though less is known about their risk.

Schneider discovered this by reviewing the literature on TBIs in first responders. She is the first to say the findings demand more research. First responders need better data on their risk, along with basics such as an accepted standardized definition of TBI and a better system of care after an injury occurs.

She aims to close some gaps by collaborating with Thomas Jefferson University colleague Katie Hunzinger to study firefighters. Hunzinger, Schneider’s former postdoctoral research, is a volunteer firefighter herself.

She also attended a key conference in March at Ohio State University, the First International Consensus Conference on Concussion in First Responders, to help develop consensus guidelines for reporting injuries and improving care. The two-day event, led by Ohio State Associate Professor Jaclyn Caccese, drew more than 50 researchers and at least 10 first responders with experience of brain trauma.

“It was a great interdisciplinary meeting,” Schneider said.

For more on her study and growing work on first responders, see her answers below:

What do we know about traumatic brain injuries in first responders?

Schneider: In talking to firefighters, police, and EMTs, we know anecdotally that there’s a problem. They will tell you they have had head injuries. But when we look at the literature, there is a void in studies looking at this, and the studies that do look at it are marked by different standards and methods. The definition of a TBI is markedly different across research. In our paper, we documented those differences. Having a consistent definition will be key going forward.

What are your main findings on traumatic brain injuries in first responders?

Schneider: TBI is common in first responders. There’s the most evidence on law enforcement. In terms of lifetime prevalence, their chances of getting a TBI, both from their life experiences and work, are upwards of 60% to 70%, which is really high. I did a prior national study in the New England Journal of Medicine in 2018, and the self-reported prevalence was 15% to 16% among U.S. adults 40 and older. The numbers for first responders are markedly higher. What this suggests for policymakers and agencies is that we need structured ways to identify injuries, treat them, and help people safely back to work.

How did your review of TBIs in first responders break new ground?

Schneider: We looked at three groups: law enforcement officers, firefighters and EMTs. We were comprehensive in obtaining all the existing literature on them. This really is the first study to synthesize all the information on TBI in first responders. It seems to be an underrecognized issue. Consider the implications of reporting a TBI: You have to go on desk duty. You are taken out of your job. There are huge implications. That’s part of what needs to be fixed.

What other issues does this study of TBIs in first responders bring up?

Schneider: Underreporting is a big issue. Another is a lack of a structured response for safely returning to duty. Everyone’s goal is to get you back to your job. It goes back to changing the culture so you can report the injury, get the care you need, and not fear any job consequences.

How did you get interested in this study?

Schneider: I’ve been doing TBI research for a while, and much of my work has focused on the long-term outcomes after trauma, such as an increased risk for dementia and heart disease. A TBI is not always just an event you move on from. In some people, it becomes a chronic condition. In that context, I’ve looked at military and hospital-based populations. With this conference, first responders were a new population.

What are the review’s limitations?

Schneider: The biggest one is the lack of evidence. There have been only a handful of studies on head injury in these populations, particularly among firefighters and EMTs. We need to think about specific risks. The ways people are getting injured on the job is different from the way it happens in the community, where falls and motor vehicle accidents are some of the most common causes.

What should health care leaders and policymakers do about trauma in first responders?

Schneider: We need standard definitions across the board, so all agencies define TBIs the same way. We also need consistent protocols focused on ensuring first responders get the help they need, delivered in a graduated way. That will require a lot of buy-in from multiple stakeholders.

Where is your brain trauma research going next?

Schneider: With first responders, Katie Hunziger, my former post-doctoral fellow and now a faculty member at Thomas Jefferson University, is starting a large-scale study focused on firefighters to better understand their experiences with head injuries. We are about to get that study launched.

We’re also working with the Centers for Disease Control and Prevention (CDC). They have a firefighter survey focused on cancer that asks one question about TBI. What is neat about it is, they collected data on occupational exposures, so we can see how those are associated with a head injury. The drawback is they have one question on TBI, so it may undercount cases.

Where is your brain trauma research going next?

Schneider: I hope this work gets people thinking about TBI in first responders. We need to make sure this is a known risk, especially for people who work these jobs. Then change can follow. We also need to really help people throughout the process. There does not seem to be enough support for people doing these jobs, and there is not yet an effective structure for getting back to work.

The study, “Systematic Review and Meta-Analysis of Traumatic Brain Injury in First Responders,” was published in the Journal of Head Trauma Rehabilitation on July 14, 2026. Authors include Katherine J. Hunzinger, Kayla Riel, Carly Smith, Thomas J. Beach, James A. Oñate, Christopher J. D’Lauro, Johna K. Register-Mihalik, Ashish R. Panchal, Jeffrey J. Wing, Jaclyn B. Caccese, and Andrea L.C. Schneider.