The Full-Circle Programs and Philosophies of the VA
The VA — along with the DoD — works with veterans and some active duty service members and their families to help them rebuild their lives after TBI and other polytrauma injuries.
The VA and the Department of Defense have a memorandum of agreement that goes back to 1993 for the VA to do complex rehabilitation for individuals who have traumatic brain injury, spinal cord injury, and visual loss, and now more recently polytrauma is getting added to that list. In the VAs, particularly in the lead polytrauma centers, we are able to treat active-duty service members, where in the VA hospital generally you're just treating veterans. That has led to really tightly integrated care for our active-duty service members with severe injuries. When we think back to many of the patients that we have treated, we are actually able to treat with our colleagues at Bethesda or, now it's Walter Reed, really hand-in-hand, so the surgeons on their end continue to manage the surgical issues of the patients while they are 110 miles away at the VA. We have frequent teleconferences, we get them back up there for surgical appointments, but you'll see an incredibly coordinated effort by medical and surgical teams and intensive rehabilitation teams that actually aren't on site. The level of collaboration that I see is better than I have seen in any hospital where all the people were in the same building. It gives us the opportunity to treat these folks and really manage them through that challenging period of time. It does break the mold to some degree, whereas in past generations, when service members went to the VA, they figured that that was the end of their career, and they were getting pushed into civilian life, whereas now we are able to work hand-in-glove with the DOD to get these folks back to hopefully the highest level of function that we can. When we talk about length of stay in the polytrauma centers for individuals who need intensive hospital-based rehabilitation, the lengths of stay can be really across the board. We run comprehensive evaluation programs for service members, so those are the walking wounded who are not really doing well in community, will come in for 2-3 weeks. We look at them from every angle that we can to try to help them find things to rebuild their lives with. Individuals typically who are severely wounded will be there anywhere from 2-4 months, generally, on the inpatient unit. While they're on the inpatient unit, we have their families there with us, there's Fisher Houses at all the VAs, and the families are really a part of the treatment team. We have no visiting hours on the units; they can stay with their loved one if they want. I know at our VA we've had 2 weddings, we've had multiple births, we've had all kinds of life events that we try to help encompass. Those service members who are severely wounded will be on the unit anywhere from 2-4 months. There is even a more severely wounded population and those are the individuals in our Emerging Consciousness Programs with disorders of consciousness or near-coma after a severe brain injury. Those individuals will typically be in our units anywhere from 3-6 months while we try to help them recover consciousness and recover any kind of function. After individuals with severe traumatic brain injury have been in our inpatient unit, at all of our lead polytrauma centers we've got community-reentry-based transitional rehabilitation programs. These are past working on the basic activities of daily living, this is working on their ability to take their medications and to do their laundry and to get back on a work site and to manage the complexities of not being a patient but hopefully being a person again at some point in life. The length of stay on the polytrauma transitional rehabilitation units is usually anywhere from 3-6 months as well.
Posted on BrainLine September 27, 2012.
Shane McNamee, MD serves as chief of Physical Medicine and Rehabilitation at the Richmond VAMC and has worked extensively on the development and implementation of the Polytrauma System of Care in the Veterans Health Administration.
Produced by Victoria Tilney McDonough and Erica Queen, BrainLine, and Dan Edblom.