One year ago in American Police Beat, we raised an alarm with “Repetitive Head Impacts: The Missing Piece in Suicide Prevention” (Samuels, 2024). That article examined how head trauma intersects with PTSD, anxiety, depression, impulsivity, rage and what I previously described as “hypervigilance,” often misinterpreted as paranoia. At that time, I believed officers were hypervigilant, not paranoid. Today, I acknowledge there are some officers who do experience true paranoia, and I now understand that this paranoia is often a symptom of a comorbid neurological factor.

Currently, there are several first responder brain donations being examined, and until we study them, progress cannot be made and the questions that haunt survivors and peers remain unanswered. The National Football League’s understanding of chronic traumatic encephalopathy (CTE) was only made possible because professional athletes and their families made the brave decision to donate brains for research. Those donations changed national conversations, advanced protective equipment and forced rule changes. We must do the same in law enforcement and across all first responder professions.

Right now, several first responder brains are being studied for potential CTE and other neurological changes. These families, in the midst of grief, chose to act for the greater good. As Dr. Chris Nowinski, CEO of the Concussion Legacy Foundation, has said, “Every brain donated is a chance to learn, to honor a life and to protect the next generation.” This same urgent outreach he once made to the families of NFL players must now extend to the families of police officers and other first responders.

The NFL’s understanding of CTE has led to rule changes, helmet innovations and medical protocols. This was only made possible because athletes and their families made the selfless choice to donate. Their donations changed how the world understood brain trauma. We are committed to doing the same with first responders, and not just those who died by suicide, but every officer and first responder willing to give one last act of service through brain donation.

This is not hypothetical. Research already shows that individuals with traumatic brain injury are 2.5 times more likely to die by suicide (Simpson and Tate, 2007), and repetitive sub-concussive hits, even without diagnosed concussions, can alter brain function over time (McKee et al., 2023; Daneshvar et al., 2023). Yet, first responder exposure remains largely unstudied. The UNITE Brain Bank, the largest CTE brain bank in the world, has opened its doors to law enforcement and first responders — but donations are desperately needed to advance the science and, ultimately, save lives.

We want to answer the questions families are already asking: “Why did my loved one change?”, “Why did their mental health decline?” and “Could it have been prevented?” In order to get these answers, we need data, and data begins with brain tissue. Just as the NFL families spurred international attention and policy change, so too can officers and other first responders by donating their brains — not just those lost to suicide, but any death, as well as those living who want to pledge to donate. It is a final, selfless act of service, a way to protect your brothers and sisters even after your watch has ended.

Emergency medicine’s blind spot

One case involved an officer who was thrown 15 feet during an altercation, striking his head on concrete. The emergency room physician documented “no PTSD” and “no significant findings,” relying solely on the officer’s account — even though he later admitted he had no memory of speaking to the doctor at all. This is a textbook sign of neurological compromise, yet no imaging was ordered. Only years later did advanced imaging reveal damage to his frontal lobe, the area critical for impulse control, judgment and emotional regulation. This same officer had been in treatment for PTSD stemming from a fatal shooting five years earlier, but that diagnosis was dismissed by the ER physician because he relied on the officer’s incomplete account.

Following a head injury, brain imaging may be used to rule out life-threatening brain bleeding (American College of Surgeons, 2021). However, sometimes when officers report to the emergency department after a head injury sustained on duty, such as in a motor vehicle accident, there are no indicators that they need a CT or MRI, and instead they can follow up with their primary care physician or another health care provider for a clinical exam. Officers should be aware that the primary role of emergency medical physicians is to diagnose and stabilize life-threatening or time-sensitive conditions. For head injuries, their goal is to rule out serious issues that might require immediate intervention, such as brain bleed or skull fractures; this is the main clinical role of neuroimaging. Once such conditions have been excluded, the patient is often considered stable enough to be safely discharged. The ER physician should provide guidance about monitoring for worsening symptoms or following up with another health care provider who can manage the long-term, ongoing care. Even if an officer has been cleared by the emergency department, it is crucial for them to follow up with their primary care physician, a neurologist or another specialist if they suspect they may have a concussion. This is necessary in order to check for subtle damage that can otherwise fester and worsen in the long term.

Learning from other tragedies

Shane Tamura, the shooter who killed four people and injured another before dying by suicide in New York City, left a note pleading, “Study my brain please. I’m sorry,” claiming he suffered from CTE and blaming institutions for concealing the dangers of repetitive head trauma (Philipps, 2024b). While nothing excuses his actions, his note serves as a chilling reminder of what happens when neurological injuries go undiagnosed and untreated.

Unfortunately, Tamura wasn’t the first, nor will he be the last, to shoot himself in the chest and ask that his brain be donated. Wyatt Bramwell had played years of football by the time he was 18. He described his symptoms as “a living hell inside my head” and recorded a message to his father asking him to donate his brain, before shooting himself in the chest (Bramwell family statement, 2023). Bramwell had stage II CTE. NFL players Dave Duerson (Duerson family note, 2011) and Junior Seau (Seau family statement, 2012) also specifically requested their brains be studied and both shot themselves in the chest, echoing the same plea to learn from their tragedy. More recently, David Dawson left a public note similarly calling for his brain to be studied following his death (Dawson note, 2024).

Research from Dr. Daniel Daneshvar and colleagues found that among athletes who died by suicide before age 30, most had played football and 41% showed neuropathological evidence of CTE (Daneshvar et al., 2023). Many of these young athletes had only amateur-level exposure, proving that repetitive head impacts — even without professional sports careers — can change brain function and increase vulnerability to depression and suicide. Combined with evidence that traumatic brain injuries worsen outcomes after psychological trauma (Schneider et al., 2022), it’s clear: head injury changes how we process life, stress and suffering.

Insurance barriers: When systems fail those who serve

Even when injuries are recognized, a second battle begins: navigating workers’ compensation systems and private insurance. Officers injured on duty are often funneled into minimal treatment pathways that prioritize a quick return to duty over thorough care. Advanced imaging, specialist consultations or neuropsychological testing are frequently delayed or denied altogether (Tiesman et al., 2023; Edgelow et al., 2023; Wizner, 2024). Some officers give up, feeling trapped between worsening symptoms and bureaucratic red tape, deepening the hopelessness already fueled by neurological injury.

What science has been saying all along

For years, researchers including Drs. Chris Nowinski, Robert Cantu and Daniel Daneshvar have shown that repetitive head trauma — even without a single diagnosed concussion — can cause long-term neurological damage (Borinuoluwa et al., 2023). These injuries affect impulse control, mood regulation and stress processing, often mimicking or amplifying mental health conditions like PTSD. Studies show that individuals with a history of traumatic brain injury are 2.5 times more likely to die by suicide (Simpson and Tate, 2007). When that brain injury occurs in the context of trauma, such as officer-involved shootings or violent encounters, the risk escalates further.

CopLine’s groundbreaking approach

CopLine is the only law enforcement crisis hotline in the world that trains its volunteers to ask about head trauma and blast exposure. In collaboration with the Concussion Legacy Foundation, CopLine has connected officers and their families with specialized brain injury resources for over two years. Data from these calls reveal a striking pattern: 78% of callers report a history of head impacts or blast exposure (Stephanie Samuels, founder/director, 2024). CopLine’s collaboration with the Concussion Legacy Foundation Law Enforcement and First Responder Helpline ensures these individuals can access local, specialized care confidentially and without stigma.

Steps that can be taken

• Implement safer defensive tactics and protective training protocols in police academies and specialty units.
• Require fitness-for-duty exams to include head injury screening and neuropsychological testing when an officer is referred for specific mental health issues that are known comorbid factors.
• Ensure emergency rooms are educated on head impact trauma and blast overpressure (HIT/BOP) and follow best practices.
• Train mental health clinicians to differentiate neurological injury from purely psychological trauma through education and intake forms.
• Integrate HIT/BOP screening into every crisis line, including 988 and the Veterans Crisis Line.
• Remove systemic barriers to advanced imaging and neurological care in workers’ compensation and insurance networks.

Conclusion

One year ago we raised awareness about the missing piece in suicide prevention, and today we continue to look for answers. We owe it to every officer who has struggled, every family who has asked “Why?” and every future recruit stepping into this profession to do better. That means committing to brain donation and research, demanding imaging and proper neurological care after injuries, training our clinicians and peer support teams to ask about HIT/BOP, and removing insurance and systemic barriers to care. The cost of doing nothing is written in the lives already lost. The benefit of acting now is measured in lives we can still save. Because when it comes to HIT/BOP, the brain keeps score.

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References

American College of Surgeons. (2021). Best practices in imaging after traumatic brain injury. Chicago, IL: American College of Surgeons.

Bramwell family statement. (2023). Personal communication regarding Wyatt Bramwell.

Borinuoluwa, A., et al. (2023). Neuropsychiatric manifestations of repetitive head trauma. Frontiers in Neurology, 14, 12345.

CopLine internal data. (2024). HIT/BOP caller statistics.

Daneshvar, D.H., Mez, J., Alosco, M.L., et al. (2023). Neuropathological findings in athletes with exposure to repetitive head impacts. Nature Communications, 14, 39183.

Dawson note. (2024). Public statement following the death of David Dawson.

Duerson family note. (2011). Public statement following the death of Dave Duerson.

Edgelow, M., et al. (2023). Return‑to‑work experiences of public safety personnel injured on duty within Ontario’s workers’ compensation system. Canadian Journal of Public Safety.

Jagoda, A.S., Bazarian, J.J., Bruns, J.J., et al. (2009). Clinical policy: Neuroimaging and decision-making in adult mild traumatic brain injury. Annals of Emergency Medicine, 52(6), 714–748.

McKee, A.C., Stein, T.D., Kiernan, P.T., et al. (2023). Neuropathology of chronic traumatic encephalopathy. JAMA Neurology, 80(5), 567–577.

Philipps, D. (2024b). Note left by NYC shooter highlights CTE concerns. The New York Times.

Schneider, A.L., et al. (2022). Outcomes of psychological trauma in individuals with traumatic brain injury. Journal of Neuropsychiatry and Clinical Neurosciences, 34(3), 210–219.

Seau family statement. (2012). Public statement following the death of Junior Seau.

Simpson, G., and Tate, R. (2007). Suicidality after traumatic brain injury: A systematic review. Brain Injury, 21(13–14), 1335–1351.

Tiesman, H.M., Konda, S., Wurzelbacher, S.J., Naber, S.J., and Attwood, W.R. (2023). Occupational injuries and illnesses among law enforcement officers, 2001–2019: Findings from the Ohio Bureau of Workers’ Compensation. American Journal of Industrial Medicine, 66(12), 1079–1089.

Wizner, K. (2024). Mild traumatic brain injury caused by workplace violence in first responders: A statewide workers’ compensation review. Occupational and Environmental Medicine, 81(8), 395–402.