74% of Officers Have Had a Head Injury. Most Never Got a Baseline.

If your agency ran a wellness survey tomorrow, the results would likely shock command staff: roughly three in four officers have already taken at least one significant head hit in their lifetime — and the majority of those injuries never produced a medical record, a baseline, or a return-to-duty plan. That is not speculation. It is what peer-reviewed research from The Ohio State University Wexner Medical Center and a 2025 national sample in the Journal of Head Trauma Rehabilitation now documents with hard numbers.

What the Ohio State data actually shows

In the first dedicated concussion surveillance study of U.S. law enforcement, researchers surveyed 381 law enforcement personnel in central Ohio about lifetime head-injury history, PTSD symptoms, and depression. The findings, published in Journal of Head Trauma Rehabilitation and widely reported in 2024, include:

• 74% reported at least one lifetime head injury
• 30% reported a head injury that occurred on the job
• More than half of injuries involved loss of consciousness, feeling dazed, or memory gaps — signs of probable mild TBI
• Fewer than 1 in 4 head injuries were diagnosed or treated by a healthcare provider
• Officers with prior head injuries showed higher PTSD and depression symptom scores

In follow-up assessment work, lead investigator Jaclyn Caccese, PhD — an assistant professor at Ohio State's School of Health and Rehabilitation Sciences and Chronic Brain Injury Program — found that approximately 70% of on-duty concussions went unrecognized, undiagnosed, or untreated. Franklin County Sheriff's Office became an early pilot site, adding instrumented mouthguards in academy training, spacing combatives for recovery, and placing athletic trainers on duty to evaluate head injuries — a model borrowed directly from sports medicine.

Silent Struggles: the 2025 picture is worse, not better

A 2025 study titled Silent Struggles: Traumatic Brain Injuries and Mental Health in Law Enforcement expanded the evidence base with a larger law-enforcement sample. Head injuries remained common — reported by roughly 74% of participants — but the headline finding for occupational health leaders was diagnostic failure: 76.7% of head injuries went undiagnosed or untreated, compared with only 23.3% that received healthcare attention. Sport-related hits and fall-related hits had especially poor reporting rates (over 70–80% undiagnosed).

The authors concluded that law enforcement needs standardized TBI monitoring, graded return-to-duty protocols, and better access to brain-injury education — language that mirrors what athletics adopted a decade ago. They explicitly recommended military-style return-to-duty frameworks adapted for officers.

Why “most never got a baseline” is the operational problem

Baselines are not a diagnosis. They are a pre-injury reference photograph of brain function — memory, concentration, balance, gait, and typical symptom levels — captured when the officer is healthy. When a cruiser is struck, a suspect's elbow connects with a temple, or a flashbang detonation leaves an operator stunned, clinicians and supervisors need an objective comparison point.

Without that reference:

• Post-injury cognitive scores are compared to population norms that miss ADHD, sleep debt, age, and prior injury history
• Symptom checklists cannot distinguish new concussion symptoms from an officer's everyday baseline stress profile
• Workers' compensation disputes default to pre-existing arguments without documented pre-injury function

See our guide on workers' comp and baseline data for how documentation changes outcomes after a line-of-duty hit.

Caccese has stated publicly that every state already requires athletes to be cleared by a medical provider before returning to play after concussion — but that model "just doesn't apply to our law-enforcement officers." The gap is not medical science. It is policy and infrastructure.

Where officers actually get hit

Ohio respondents reported head injuries from sports (often predating their career), falls, being struck by objects or people, motor-vehicle crashes, and blast exposure. On duty, the mechanisms align with what patrol and corrections supervisors see weekly:

• Physical altercations and use-of-force encounters
• Vehicle pursuits and cruiser strikes — often with delayed medical evaluation
• Training-academy combatives and boxing-style drills
• Tactical breaching, flashbangs, and repeated firearms exposure
• Inmate assaults in jail and prison settings

Unlike a Friday-night football game with an athletic trainer on the sideline, these injuries occur in chaotic environments where the priority is scene control, not SCAT6 scoring. That makes pre-injury baselines more important, not less — because the post-injury assessment will almost always happen hours later, in an ER or the next morning when the officer insists they are fine.

What agencies can do this year

You do not need a hospital contract to start. Mature programs begin with three steps:

1. Baseline every sworn officer (and high-risk corrections staff) during onboarding or annual fit-for-duty — self-administered digital baselines on a phone take roughly 15 minutes and fit shift schedules
2. Train supervisors on red-flag symptoms and mandatory reporting
3. Adopt a graduated return-to-duty checklist before unrestricted contact — modeled on return-to-play and Public Safety Medicine guidance

For clearance authority basics, start with who can clear a concussion.

Franklin County's pilot demonstrates that mouthguard impact monitoring in academy training, athletic-trainer sideline coverage, and post-crash evaluation protocols are feasible in real sheriff's offices — not just university labs. The Mid-Atlantic Concussion Alliance and other regional programs offer free or low-cost baseline screening models agencies can benchmark.

The bottom line for chiefs and union leadership

74% lifetime head-injury prevalence is not a fringe wellness topic. It is a workforce exposure rate that would trigger immediate intervention in any factory or collegiate athletic department. The 70–77% undiagnosed fraction means your agency's incident reports are capturing the tip of the iceberg.

Baselines will not prevent the next hit. They give you the data to recognize when an officer's brain is not back to their normal, document recovery, reduce second-impact risk, and support mental-health referrals when PTSD and TBI symptoms overlap — a connection the same research programs are now tracking longitudinally.

For a deeper look at building department buy-in, read Badge, Gun, and Baseline and our upcoming return-to-duty protocol series. If you lead a jail or prison system, pair this with first-responder brain-health gaps in fire and EMS.