Polytrauma Center Care and the TBI Patient: How Seamless is the Transition between VA and DoD and Are Needs Being Met?

Congressional Testimony   “Polytrauma Center Care and the TBI Patient: How Seamless is the Transition between VA and DoD and Are Needs Being Met? ”   Subcommittee on Health of the Committee on Veterans’ Affairs   Chair Rep. Michael Michaud   Thursday, March 15, 2007, 2:00 pm   Written Testimony   Tina M. Trudel, PhD President and Chief Operating Officer, Lakeview Healthcare System, Inc. Principal Investigator, Defense and Veterans Brain Injury Center at Virginia NeuroCare Assistant Professor of Clinical Psychiatry and Neurobehavioral Sciences, UVA Medical School Former Chairperson, NH Brain & Spinal Cord Injury Advisory Council Chairperson, Long Term Issues Task Force, American Congress of Rehabilitation Medicine     Representative Michaud, members and staffers of the Congressional Subcommittee on Health of the Committee on Veterans Affairs, thank you for allowing me the opportunity to participate in this briefing to discuss the care of veterans with brain injury.  My name is Dr. Tina Trudel.  I presently serve as President and Chief Operating Officer of Lakeview Healthcare Systems, a national provider of brain injury services from hospital to home.  I also serve as Principal Investigator of the Defense and Veterans Brain Injury Center at Virginia Neurocare, a civilian brain injury rehabilitation site.  I have been an advocate, researcher, professor and clinician in the field of brain injury rehabilitation for the past 20 years.   This experience has heightened my awareness of the disconnection between our investment and advances in emergency management and acute care of brain trauma, versus the lack of resources available for post-acute treatment, community integrated rehabilitation and long term supports.  Be it in the civilian or military community, there is a longstanding gap in meeting the long term needs of the growing population of brain injury survivors.  It appears we have yet to accept that saving lives has consequences.   As others in the media have noted, brain injury is perhaps our greatest public health problem.  It cuts across the age span, from infant to elderly, and affects our military both during war and peace time.  Those with traumatic brain injury (TBI) are adversely impacted by the lack of funding and underdeveloped infrastructure in comparison to other diagnostic and disability groups.  Not very long ago, individuals with brain injury often died, and until the National Head Injury Foundation (now Brain Injury Association of America) was founded by in the 1980’s, there was no organized voice of advocacy and acknowledgement.  While this recent era spawned improved survival and the brain injury movement, our national and state health and human services structures were already well-established.  The funding train had left the station, and people with brain injuries were still waiting at the ticket counter.  Brain injury has become a leading public health problem for civilians and the military.  In the United States civilian population, 1.4 million individuals sustain traumatic brain injury (TBI) annually resulting in 235,000 hospital admissions and 50,000 deaths (1).      Additionally, 80,000 survive with residual long-term impairments.  The Centers for Disease Control and Prevention estimate that long-term disability as a result of brain injuries (necessitating assistance with activities of daily living) affects 5.3 million Americans, with thousands of new individuals affected every year (2).  This population continues to grow and age, creating greater challenges that must be met by an already burdened health and human services system.   Economically, the total impact of direct and indirect medical and other costs in 1995 dollars is reported to exceed $56 billion (3).  Such costs do not include lost earning potential, family burden of care, special education, vocational retraining and a host of related issues as now are being recognized within the military.  While blast injury and combat related TBI are presently in focus, it is important to remember that military service runs a risk of TBI even in peace time, with thousands of military personnel injured annually due to motor vehicle crashes, falls, training mishaps and other causes.