The ThinkFirst Foundation: Expanding the Footprint of Neurological Injury Prevention

David Dornbos III, MD
Debby Gerhardstein, RN, BSN, MA

A major threat to the longevity of an American pastime, the leading cause of death in young adults or a major contributor to disability in the elderly – pick your poison. Neurotrauma remains at the forefront of the media and the waiting room of your local emergency department. And while politicians are impacting legislation and leagues are enacting rule changes, neurosurgery is in a unique position to serve communities and patients from a grassroots level.

The ThinkFirst National Injury Prevention Foundation has been a standard bearer for injury prevention of both brain and spine trauma for decades, relying on the support of neurosurgeons, individuals, grants, corporate sponsors and national organizations. ThinkFirst provides an avenue for the neurosurgical specialty to impact public health in their local communities. Organized by the AANS and CNS, ThinkFirst started more than 30 years ago with mission to tackle a significant health crisis of injuries and deaths from impulsive teen behavior, an epidemic causing incurable brain and spinal cord injuries.

After witnessing a positive response to local, community-based injury prevention programs, they developed a theory-based national program, and the ThinkFirst Foundation was born. Shortly thereafter, neurosurgeons throughout the United States began involving their staff to generate ThinkFirst chapters, providing programs to teens in their local communities. Further expansion beyond the teen population spawned several new programs aimed at neurologic injury prevention in other demographics, including younger children, infants and the elderly.

In the 2018 Global Status Report, the World Health Organization identified that road traffic injuries have become the leading cause of mortality between the ages of 5-29 years old. Due to this growing public health concern and its association with neurologic injury, ThinkFirst has developed programming to include road safety-specific programs. This new initiative builds on programming on proper car seat use in the ThinkFirst For Your Baby program and has added new road safety-specific curricula in the Kids, Youth and Teens programs for teens and parents of teen drivers. Soon, ThinkFirst to Prevent Falls (a program serving the elderly) will include a traffic safety program on safe driving for older adults.

As the road safety focus has continued to grow, new partnerships have developed, allowing the ThinkFirst mission to reach an increasingly growing group of individuals. ThinkFirst recently partnered with General Motors (GM) through a grant that began September 1, 2018. The project Expanding Traffic Safety Programs to High Risk Road Users focuses on expanding the number of chapters throughout the U.S. and to enhance educational materials and messaging through media outlets, social media and publicly available curriculum. Pleased with the outcomes, GM renewed the grant in September 2019 for fiscal year 2020.

In addition to the work with GM, ThinkFirst has also started a collaboration with the Illinois Department of Transportation (IDOT). In October 2018, IDOT awarded ThinkFirst a Highway Safety Grant for Injury Prevention. This grant specifically focuses on expanding the educational road safety-related program materials for teens and parents of teen drivers. Programs focus on safety measures for reducing crashes, injuries and deaths among new, inexperienced drivers in Illinois. Additionally, the materials developed from this grant allow for easy modification for use by injury prevention professionals in other states.

The power of ThinkFirst is that it does not rely on periodic presentations on injury prevention, but does rely on ThinkFirst chapters deeply engrained in their local communities promoting a culture of safety. The ThinkFirst network has continued to expand with over 140 chapters within the United States and more than 35 international programs, providing more than 6,000 presentations each year to schools and community groups. Despite this success, there is plenty of opportunity to expand, as large communities exist without local chapters.

Chapters are easy to establish. Each chapter has a physician who serves as the medical director and champions program promotion. Injury prevention professionals who serve as chapter directors include nurses, physical or occupational therapists and educators. Trained chapters operate independently through hospitals, university medical centers, private practices and other organizations, using ThinkFirst materials and programs to deliver a message of injury prevention to people in their local communities. Check the Chapter Directories under ‘Chapters’ at to see if a chapter is needed near you, or if there is a nearby chapter with which to get involved. If no chapter exists, please visit or give us a call at (630) 961-1400. Join the network of neurosurgical providers utilizing ThinkFirst programs to reduce the incidence of traumatic injury.

After completing training, chapters have access to program materials, including videos, slides, scripts and evaluation tools for each of the programs. Materials are regularly updated; this past year another video, Decisions Matter, was produced for teen programs featuring ThinkFirst VIP speakers sharing personal stories of brain or spinal cord injury. An invaluable resource for hospitals, this saves the burden of developing these community outreach programs.

In addition to the developed programs, there are also injury prevention resources on the website. Under ‘Facts and Publications’ you 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.

As ThinkFirst advances into this new chapter, we thank Executive Director Debby Gerhardstein, for her 12 years of service as she enters retirement. Her invaluable leadership has led to the development of multiple new programs, dozens of new chapters and partnerships that have provided ThinkFirst with resources that will propel the organization’s mission. We also welcome Susan Crotty as she steps into the Executive Director role and are excited to see how she shapes and leads the Foundation.

The ThinkFirst Foundation is healthy, thriving and expanding its footprint with new initiatives and collaborations, and neurosurgeons are leading the way. Join the movement, start a local chapter and give ThinkFirst an opportunity to impact the lives of those within your community.