1.1
Conduct Immediate Stabilization & Neurological Exam
Assess cranial nerves, balance and gait, visual tracking, and cognitive orientation.
Medical assessment and referral for potential AHI
A searchable clinical pathway for government healthcare providers assessing a possible Anomalous Health Incident, including events sometimes described as Havana Syndrome.
Reporting an Anomalous Health Incident (AHI)—often associated with unexplained, sudden sensory events or ‘Havana Syndrome’—requires a precise combination of clinical triage, specialized documentation, interagency reporting, and long-term surveillance.
For healthcare providers, particularly within the Department of Defense, Department of State, and affiliated federal health systems, the standard operating pathway is organized into four operational steps.
Step 1
Immediate Triage and Red Flag Elimination
Evaluate urgent or life-threatening conditions before classifying symptoms as an AHI.
Rule out acute stroke, intracranial hemorrhage, encephalitis, carbon monoxide poisoning, acute vestibular failure, and other emergent causes.
1.2
Review Incident Onset Criteria
Document whether a sudden sensory event—such as loud localized noise, intense pressure, localized heat, or a directed directional force—occurred concurrently with or immediately before symptoms.
Symptoms to record: headache, disequilibrium, nausea, memory fog, or sleep disruption.
Step 2
Acute Clinical Documentation
Within seven days of a suspected exposure, augment standard charting with dedicated federal AHI assessment tools.
2.1
Administer DHA Form 244
Complete the Defense Health Agency AHI Acute Assessment Form to systematically log environmental context, exact timeline, sensory characteristics, and early physical signs.
2.2
Collect Time-Sensitive Biomarkers
If drawn within the acute window, order baseline blood work and request specific biomarkers if local laboratory protocols permit, including γ-H2AX for early DNA damage repair pathways or serum neurofilament light chain (NfL) for axonal injury.
Record unique localized tissue patterns, such as non-contact sub-dermal inflammation, in the medical record.
Step 3
Reporting & Interagency Interoperability
Route suspected cases through organizational channels for care continuity, benefits protection, and security awareness.
3.1
Submit to the AHI Registry / Program
DoD Personnel
Log the completed DHA Form 244 in the patient’s electronic health record (EHR) and upload the data to the central DHA AHI Clinical Registry.
State Department / Diplomatic Personnel
Contact the Bureau of Medical Services (MED) to submit an incident report to the State Department’s AHI intake coordinator.
3.2
Notify Security / Command
Remind the patient to notify their Unit Security Officer, Command Element, or Counterintelligence (CI) representative regarding the temporal and geographic location of the event.
3.3
Escalate to the National Call Center
For complex presentations or specialized clinical consults, contact the AHI Call Center at the National Intrepid Center of Excellence (NICoE) / Walter Reed National Military Medical Center.
Step 4
Referral & Post-Assessment Care Pathways
If no alternative primary diagnosis explains the acute symptoms, move to symptom-guided management and specialized care.
4.1
Initiate Progressive Return to Activity
Apply symptom-guided primary care management modeled on Traumatic Brain Injury Center of Excellence (TBICoE) concussion protocols: vestibular therapy, cognitive rest, and gradual exertional steps.
4.2
Specialty Facility Referral
Refer persistent or non-responsive symptoms to a regional Intrepid Spirit Center (ISC) or directly to NICoE for comprehensive interdisciplinary neuro-trauma and specialized imaging evaluation.
Summary Checklist for Health Care Providers
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Key Terms & Clinical Glossary
Concise definitions for the forms, programs, biomarkers, facilities, and reporting terms used throughout this guide.
- AHI
- Anomalous Health Incident — an unexplained, sudden sensory event associated with acute neurological or sensory symptoms.
- DHA Form 244
- The Defense Health Agency AHI Acute Assessment Form used to document the event context, timeline, sensory characteristics, and early physical signs.
- NICoE
- National Intrepid Center of Excellence, located at Walter Reed National Military Medical Center, providing specialized interdisciplinary evaluation.
- NfL
- Neurofilament light chain, a serum biomarker that may be evaluated for evidence of axonal injury when local protocols permit.
- γ-H2AX
- A marker associated with early DNA damage repair pathways that may be considered in the acute window when local laboratory protocols permit.
- HAVANA Act
- A 2021 federal law addressing support and benefits for qualifying U.S. government personnel affected by certain injuries.
- ISC
- Intrepid Spirit Center — a regional facility providing interdisciplinary care for persistent or non-responsive symptoms.
- TBICoE
- Traumatic Brain Injury Center of Excellence, whose concussion protocols inform symptom-guided progressive return to activity.
- CI
- Counterintelligence — the representative or function that should receive relevant temporal and geographic incident details through organizational channels.
- PRA
- Progressive Return to Activity — a symptom-guided approach using cognitive rest, vestibular therapy, and gradual exertional steps.
- EHR
- Electronic Health Record — the clinical record where the completed DHA Form 244 should be documented for DoD personnel.
Contacts & Resources
Use the national AHI clinical contact for complex presentations, specialty consultation, and referral guidance.
National Clinical Contact
Walter Reed / NICoE AHI Call Center
National Intrepid Center of Excellence at Walter Reed National Military Medical Center.
DoD pathway
Document in the EHR and submit to the central DHA AHI Clinical Registry.
State pathway
Contact the Bureau of Medical Services (MED) AHI intake coordinator.
Security pathway
Notify the appropriate Unit Security, Command, or CI representative.