1. Clinical Care in Neurotrauma: Nursing Perspectives Department of Defense Programs to Support TBI Care Kathy Helmick, MS, CRNP, CNRN Deputy Director, TBI, Defense Centers of Excellence for Psychological Health and TBI
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3. High Level Attention Mental Health Task Force Independent Review Group (IRG) Task Force on Returning Global War on Terror Heroes DoDIG Review of DoD/VA Interagency Care Transition Veterans Disability Benefits Commission (www.vetscommission.org) Commission on Care for America’s Returning Wounded Warriors
4. The Structure Personnel , Pay & Financial Spt Disability System Disability Advisory Council Overarching Integrated Product Team (OIPT) Full-time staff and VA Detail Case Management Summit BEC/HEC Working Group CPI Group Incoming from other commissions Red Cell TBI/Psychlogical Health Case Management DoD/VA Data Sharing Facilities Clean Sheet Review Legislation & Public Affairs 1 2 3 4 5 6 7 Senior Oversight Committee (SOC) Co-Chairs: DEPSECDEF and DEPSECVA 8 As of June 29, 2007
5. National Defense Authorization Act 2008 SEC. 1621. CENTER OF EXCELLENCE IN THE PREVENTION, DIAGNOSIS, MITIGATION, TREATMENT, AND REHABILITATION OF TRAUMATIC BRAIN INJURY. (a) In General- The Secretary of Defense shall establish within the Department of Defense a center of excellence in the prevention, diagnosis, mitigation, treatment, and rehabilitation of traumatic brain injury, including mild, moderate, and severe traumatic brain injury. SEC. 1622. CENTER OF EXCELLENCE IN PREVENTION, DIAGNOSIS, MITIGATION, TREATMENT, AND REHABILITATION OF POST-TRAUMATIC STRESS DISORDER AND OTHER MENTAL HEALTH CONDITIONS. (a) In General- The Secretary of Defense shall establish within the Department of Defense a center of excellence in the prevention, diagnosis, mitigation, treatment, and rehabilitation of post-traumatic stress disorder (PTSD) and other mental health conditions, including mild, moderate, and severe post-traumatic stress disorder and other mental health conditions.
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8. Severity Rating for TBI Traumatic Brain Injury Description GCS - Glasgow Coma Score AOC - Alteration of consciousness LOC - Loss of consciousness PTA - Post-traumatic amnesia Severity GCS AOC LOC PTA Mild 13-15 ≤ 24 hrs 0-30 min ≤ 24 hrs Moderate 9-12 >24 hrs >30min <24 hrs >24hrs <7 days Severe 3-8 >24hrs ≥ 24 hrs ≥ 7 days
9. TBI Clinical Standards: Severity, Stages, Environment Mild Moderate Severe Penetrating Acute Sub-Acute Chronic In-theater CONUS In-patient Outpatient Community Types of TBI TBI Post-Injury Stages Levels of TBI Care
18. Continuum of Care Prevention Surveillance Screening / Assessment Diagnosis Case Management Treatment Rehabilitation Reintegration
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26. Continuum of Care Prevention Surveillance Screening / Assessment Diagnosis Case Management Treatment Rehabilitation Reintegration
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28. Continuum of Care Prevention Surveillance Screening / Assessment Diagnosis Case Management Treatment Rehabilitation Reintegration
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30. Please visit www.dvbic.org to obtain contact information for your regional education or care coordinator. DVBIC Regional Education and Care Coordination Areas MONTANA WYOMING IDAHO WASHINGTON OREGON NEVADA UTAH CALIFORNIA ARIZONA NORTH DAKOTA SOUTH DAKOTA NEBRASKA COLORADO NEW MEXICO TEXAS OKLAHOMA KANSAS ARKANSAS LOUISIANA MISSOURI IOWA MINNESOTA WISCONSIN ILLINOIS INDIANA KENTUCKY TENNESSEE MISS ALABAMA GEORGIA FLORIDA SOUTH CAROLINA NORTH CAROLINA VIRGINIA WV OHIO MICHIGAN NEW YORK PENN MARYLAND DELAWARE NJ CT RI MASS MAINE VT NH ALASKA HAWAII WRAMC Landstuhl, Germany Fort Bragg BAMC & Wilford Hall Fort Hood Camp Lejeune NMC San Diego & Camp Pendleton Palo Alto, CA Fort Carson, CO Minneapolis, MN Charlottesville, VA Johnstown, PA DVBIC HQ- Washington, DC Richmond, VA Tampa, FL San Antonio, TX
31. Continuum of Care Prevention Surveillance Screening / Assessment Diagnosis Case Management Treatment Rehabilitation Reintegration
VDBC – NDAA 2004. Membership: 13 Member commission – 12/13 Mil Experience. (4/13 Flag/General Officers). Chairman : James Terry Scott , LTG, USA (Ret) 2 Congressional Medals of Honor 2 Distinguished Service Crosses 9 Silver Stars 6 Distinguished Flying Crosses Senior Coordinating Group was stood up to provide a steering entity for DoD’s efforts in the wake of all recommendations. It has since evolved into the Senior Oversight Group which is sort of the Senior Coordinating Group with an expanded and more structured role. Co-chaired by DEPSECDEF and Secretary Mansfield. Actual structure & duties/responsibilities are being briefed to the leadership today for final approval. Commission: Honorable Bob Dole and Donna Shalayla IRG Honorable Togo West and Jack Marsh
Under the leadership of Army Brig. Gen. Loree K. Sutton, special assistant to the assistant secretary of defense for health affairs, DCoE was created in November 2007
An issue of relevance to OIF is that returning service members often report exposure to repeated blasts and other concussive events. We know that recovery is impaired with repeated concussions. The worst case scenario is “second impact syndrome” in which a second impact received before the brain has had a chance to heal from a prior injury can lead to an extreme chain of biochemical events that can actually result in death. So it is important to assess for exposure to prior events, to follow these patients more closely and have different expectations regarding the expected level of symptoms and rate of recovery.
R3 = Rehabilitation, Recovery & Reintegration
Listed here are common postconcussive symptoms in the three areas. Common physical symptoms that we see include headaches and dizziness or balance problems. In terms of emotional symptoms, irritability and mood lability are particularly common in returning servicemembers. Cognitive complaints most commonly endorsed include poor concentration and short term memory problems.
The sites in gray have both RECs & RCCs but do not gave regional responsibilities.
Our treatment of mTBI follows evolving evidence-based clinical practice guidelines, to induce: VA/DoD mTBI CPG DoD Clinical Guidance (2008) In-theater mTBI CPG … which are consistent with National standards.
Sonja
Accumulation of abnormal Tau protein in the form of NFTs and NTs in the brain has been confirmed to cause neurodegeneration, cognitive impairment and dementia. A study commissioned by the NFL reports that Alzheimer’s-like memory-related disease appears to have been diagnosed in the league’s former players vastly more often than in the national population – including a rate of 19 times the normal rate for men ages 30 through 49. - Study conducted by University of Michigan’s Institute for Social Research
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