Rapid Military Triage of Traumatic Brain Injury Using Eye Tracking and Pupillometry

Rapid triage in military operations must reliably identify hidden neurological impairment among soldiers who appear only slightly wounded. Mild to moderate traumatic brain injury (TBI), concussion, blast-related injury and neurotoxic exposure can present with subtle early signs that are easily missed under stress, time pressure and resource constraints. Eye tracking and pupillometry are promising for early triage because they probe brainstem, autonomic and oculomotor function, can be captured quickly with deployable devices and provide quantitative, repeatable measures suitable for decision support. This paper proposes a research program to develop an eye tracking-based, explainable rule base with operational thresholds for early military triage. The goal is a field-ready decision logic that estimates the likelihood of clinically relevant impairment, including concussion or moderate TBI, severe TBI warning signs and cholinergic neurotoxic syndromes, in walking-wounded soldiers and outputs a transparent high-, medium- or low-risk recommendation aligned with medic workflows. The proposed rapid assessment combines pupillary light reflex metrics, basic oculomotor screening and short mobile cognitive-oculomotor tasks. Candidate rules are derived from clinical and applied evidence and formalized as interpretable if-then statements with thresholds, confidence flags and explicit handling of illumination, fatigue, stress, motion, partial occlusion and medication confounds. Expected outputs include a prototype triage tool, an initial threshold library for pupil and oculomotor features and a staged validation plan with practical performance targets emphasizing high sensitivity for clinically relevant TBI risk while maintaining operational specificity. Future work will establish normative baselines, simulated field trials and prospective evaluations in training environments, with iterative integration of other physiological measures where beneficial.