The ThinkFirst Foundation: A Lifespan Approach to Injury Prevention

19 March 2025

David Dornbos III, MD; Jill Braselton, RN

It’s been nearly 10 years, but I (DD) still remember the accident vividly. My recollection of the cycling crash itself is completely absent, but the terror of waking up in an MRI scanner in the hospital where I was a neurosurgical trainee has never left me. I was an avid cyclist, ridden thousands of miles, and executed a solo cycling trip across the United States without a major crash or issue. I was lying helpless in the ICU recovering from a cycling accident that left me with a skull fracture and a traumatic brain injury. Fortunately, in no small part thanks to my cycling helmet, I was able to recover. My helmet, fractured into multiple pieces, reflexively put on that afternoon, had protected me from a severe injury and gave me in a much better chance to recover. Without this simple protection, my injuries could have been much more significant.
The ThinkFirst Foundation injury prevention organization is in essence the public health
mission of organized neurosurgery in the United States – pioneered in a joint effort by both the Congress of Neurological Surgeons (CNS) and the American Association of Neurological Surgeons (AANS) in 1986. The Foundation was started with a singular mission: “to prevent brain, spinal cord and other traumatic injuries through education, research, and advocacy.” Launched by two neurosurgeons nearly 40 years ago, Dr. Clark Watts and Dr. E. Fletcher Eyster shared a mission to tackle a significant health crisis: the astounding number of injuries and deaths from impulsive teen behavior, resulting in devastating brain and spinal cord injuries. They developed a theory-based national program, recruiting their staff to start ThinkFirst chapters to provide programs for teens in local communities across the United States.
ThinkFirst programmatic development revolves around the Health Belief Model, which
states that to invoke behavior change, a person must recognize that something serious in the form of disease or injury could indeed happen to them, and that there is something relatively simple they can do to prevent it. Importantly, it is paramount to continue with reminders on a regular basis to keep the messaging in mind. To facilitate this, many chapters and national programming involves messaging from VIPs (Voices for Injury Prevention), wherein a former trauma patient details a personal story, how it affected them, and how it potentially could have been prevented.
ThinkFirst programming started with ThinkFirst For Teens, designed and targeted for this high-risk population. The teen program was initially developed for classroom presentations with three primary components for injury prevention: (1) “Harm's Way," which included several award winning videos produced to kick off the presentation, (2) educator presentation, using models of the brain, skull and spinal column to explain how injuries occur, why injuring the brain or spinal cord can lead to permanent disabilities and how to avoid injury, and (3) testimony from a VIP speaker, sharing their personal story of how they acquired a brain or spinal cord injury and how it affected their life. Within just two years, 115 chapters across the United States were trained – leveraging these educational materials in classrooms throughout the country.
Chapters have grown throughout the United States, leading to the development of programs
in French, Spanish, and other languages. There were 30 international chapters providing ThinkFirst programs in communities across the globe prior to Covid-19. Not only has chapter growth and disbursement of ThinkFirst educational material been impressive, but growth in the breadth of content has also allowed the ThinkFirst mission to reach out to the community across the lifespan of human traumatic brain and spinal cord injury – beyond the teenage years.

The initial focus after ThinkFirst For Teens was on the younger patient population, with ThinkFirst For Kids. Chapters incorporated helmet-fitting events for schools using grants from businesses and government agencies to fund helmets and other chapter outreach events. Several years ago ThinkFirst benefited substantially from a three-year study funded by the US National Highway Traffic Safety Administration which revealed a significant benefit in providing booster seats and safety education for children and parents, a key component of ThinkFirst For Kids.
With the continued expansion of ThinkFirst programs, new safety education programs have targeted individuals of all ages. New programming targets traumatic brain and spinal cord injury in infants to teens to the elderly. ThinkFirst For Your Baby was developed for new and expectant parents, grandparents, and caregivers, providing guidance to create a safe environment for infants and families. ThinkFirst For Your Baby focuses on infant development, car seat and booster seat awareness, home safety, abusive head trauma/shaken baby syndrome, and more. On the other end of the age spectrum are ThinkFirst to Prevent Falls and a program recently developed to decrease traffic-related injuries in the elderly – ThinkFirst For Life presents methods to enhance driving safety. These programs for the elderly provide guidance to protect oneself, maintain safe mobility, and remain independent for as long as possible.
In addition to these programs, there are injury prevention resources on the www.thinkfirst.org website. Under ‘Facts and Publications’ one can access published articles on ThinkFirst, as well as a number of injury prevention ‘Fast Facts’ publications that provide quick access to talking points for interviews and papers. Need a handout for kids on fitting their helmet correctly? There are two to choose from. Need it in Spanish? It’s there, thanks to the Spanish translation team of ThinkFirst neurosurgeons from Mexico, Chile, and Honduras.
ThinkFirst Foundation's vast network of chapters has influenced public policy initiatives and continues to expand to those most vulnerable for traumatic injuries: our children, teens, and young adults. Treating patients who have sustained traumatic injuries, physicians and health professionals are natural spokespersons for injury prevention. Trauma, rehabilitation and children's hospitals, and medical universities find ThinkFirst offers the speaker training, chapter support, and program materials they need to provide injury prevention educational programs. ThinkFirst encourages health professionals to become involved – start chapters or work with existing chapters – to help lower the incidence, cost, and devastation of traumatic injuries.
There is a great need for injury prevention programs within the country and internationally; neurosurgery should be leading the charge in preventing brain and spine cord injuries. Neurosurgeons are in a unique position to assist in public education and safety awareness in their institutions and local communities. The ThinkFirst Injury Prevention Foundation provides the material, resources, and culture to be a major asset in neurotrauma prevention worldwide.
A simple helmet saved me from a potentially catastrophic injury with devastating
consequences. ThinkFirst's dynamic, interactive, evidence-based programs help students understand the importance of making safe choices related to traffic, bike, and sports safety, concussion recognition, and violence prevention. Adult classes include infant and family safety for new parents, safe driving practices for parents of teen drivers, and fall prevention and driving safety for older adults. Chapters are typically hospital-based and are located throughout the United States and internationally. With already 30 international chapters, the ThinkFirst Founda- tion is actively looking to partner with additional institutions and neurosurgeons around the globe. Our message is simple and in our name: Use your mind to protect your body: Think First!

Wfns March 2025