Blast Injury Assessment Across Systems

1. Blast Injury Assessment Across Systems

2. Primary Blast Injuries (PBI) • Blast injuries have increased significantly in modern warfare. • Survival rates of PBI have increased • PBI injuries can be very complex, affecting entire body systems • Cause of PBI “overpressure to gas-containing organ systems, with most frequently injury to the lung, bowel, and inner ear” (p. 403).

3. Severe Blast Injuries • Total-body disruptions are common • Death is very common to those closest to blast injury site • Common injuries include: burn injuries, inhalation injuries, traumatic-limb or partial-limb amputation, traumatic brain injury, and emotional conditions such as emotional shock, posttraumatic stress disorder (PTSD).

4. Secondary/Tertiary Blast Injury • Secondary Blast Injury • Fragments from missiles and other debris from Blast injuries are common • Can cause head injuries and soft tissue injury • Tertiary Blast injury • Displacement of entire body is common due to shock waves and dynamic overpressure

5. Miscellaneous blast-related injuries • Crush injuries are caused by displaced heavy objects and collapsed structures. Example would be a motor vehicle landing on individual due to force of blast. • Soft tissue injuries, bone fractures, and amputations are common

6. Polytrauma can effect • Mental Health • Social interactions, relationships • Emotional stability • Physical Body • Multiple organs or systems

7. Possible Involved Professionals • Speech and Language Pathologists • Physical Therapists • Psychiatrists • Social Workers, Family Counselors • Vocational Rehabilitation Counselors • Medical, e.g. • Audiologist, neurologist, pain specialist, prosthetic specialist, gastroenterologists, ENT, cardiologists, orthopedists, vein specialists, etc.

8. Best Practices • Accurate, detailed information shared in a timely manner- to improve patient outcomes • HIPAA and privacy ethics closely followed

9. HIPAA • Protects “individually identifiable health information” • Name, address, DOB, SSN, etc. • Regardless of media: e.g. electronic, paper, verbal, etc. • Past, present and future • Physical/mental health status, condition, diagnosis, etc.

10. “Covered Entity” • Provide or pay for medical/mental health care • Must have a “written authorization” to disclose protected information • Cannot base payment or treatment on getting authorization to release information • Must make reasonable efforts to disclose only minimum information, only as needed

11. Penalty for Noncompliance • $50,000 per offense • Criminal penalties up to $250,000 • Up to 10 years in prison

12. Collaboration Necessary for Best Possible Outcomes

13. Potential Benefits • Information sharing • Uniform treatment • Scheduling • Not wasting resources by overlapping or duplicating services • Filling gaps in service

14. Potential Pitfalls • Difficult to develop and maintain collaboration • Reduction of individual effort: “social loafing” • Conformity/obedience • Groupthink • Risky Shift or Group Polarization • Privacy: share only “need to know” info • Devaluing input from “lesser professionals” • Not clearly identifying roles and boundaries

15. To Avoid Pitfalls • Each professional understand and respect others expertise and “value” to team • Respect patient’s autonomy: let him/her govern care to extent possible • Collaborate frequently • Transfer information to other professionals as patient moves (e.g. “back home” after being in a military hospital)

16. Rural Issues Associated with TBI

17. TBI • TBI is a commonly sustained blast injury that can pose a threat to veterans living in rural communities. • 44% (6.1 million) of men and women in the United States Armed Forces live in rural communities. • People with TBI living in rural areas were over two times more likely to be ill and dependent on others than those from urban areas.

18. Medical and Other Service Issues • Multiple TBI is more prevalent in people living in rural communities. • Women with TBI from rural communities -financial hardship and difficulty accessing services, transportation, information and service coordination. • Limited access to medical services = many health complications that may result in long-term functional difficulty. • Outpatient TBI services are more readily available in urban areas.

19. Vocational Issues • In DVR, maintenance services were provided to 46% of urban clients and 21.4% of rural clients • On the job training- 7.1% rural clients 28% urban • Transportation- 10.7% rural clients 36% urban • Services were more costly for consumers in urban areas. • 24% of urban clients were successfully placed and 7% of rural clients were vocationally successful.

20. Vocational Issues Continued • Of rural clients, 79% qualified for services but were closed before services were offered or completed. This happened to 52% of clients from urban areas. • Multi-disciplinary services are lacking in rural areas due to shortage of qualified rehabilitation professionals.

21. Medical Solutions • The Rural Veterans Access to Care Act of 2003 requires that 5% of funds appropriated to the VA for medical care must be provided to those veterans living in rural areas . • Office of Rural Health provides $250 million per year to ensure that vets have access to quality healthcare. • Training family as paraprofessionals

22. VA/VR: Urban • Issue: Problem • Case loads are too big • Could give better service if smaller case loads • More individual attention • So, relies on client, family, etc. to create solid plans

23. Case Study: Urban Veteran • Male Veteran- 29 years old, 3 tours in Iraq • Diagnosis: TBI w/ concussion from IED, severed artery, calf injuries • Services are within 8 miles of home • Receives medical care, mental health services, and the GI Bill • Reports receiving comprehensive services

24. VA SW Case Study • VA social worker • 10 years experience: VA hospital • Good collaboration: • Easy access to treating professionals • Easy access to records/treatment plans/schedules, etc. • Good team culture

25. VA SW Case Study Cont… • Issues and Problems • Active duty clients need services coordinated with DOD • Added level of complexity and bureaucracy • Can delay treatment and funding approval • After release from VA Hospital • Seamless transition and coordination with new providers • Rural issues • Travel • Availability of specialists/experts

26. VA/VR: Rural • 18 yrs experience in rural state • Over 300 in caseload, most over an hour away • Collaboration basically consists of: • Initial assessments and eligibility (not much ongoing) • Except for: • Cognitive delay and • Mental Health issues • Done mainly through technology • Phone, fax, email, etc.

27. Case Study: Rural Veteran 1 • Male Marine- 26 years old served 2 tours in Iraq- Hit an IED • Diagnoses: TBI, Back Injury, Shoulder Injury, PTSD • Initial treatment-comprehensive • Moved home to rural area- services difficult to access and disjointed • Travels over an hr. to get VA/VR and medical care. Other services up to 3 hrs. away

28. Rural Veteran 1 Cont… • Must schedule medical appointments as needed- problem because of TBI • Receives no mental health services right now because VA professional moved.

29. Rural/ Urban Suburb Veteran 2 • Male- 27 yrs old 2 tours in Iraq w/ Army National Guard • Diagnoses: TBI (multiple concussions), and PTSD • Travels 45 min. each way to get medical services- receives no other services because Voc Rehab asked him to participate in mental health counseling

30. VA/VR: Rural: toward solutions • More funding overall • More counselors • Lighter case loads • More emphasis on the client- agency allows more individual time • Technology: • Video conferencing • Medical record database access

31. Vocational Solutions Cont… • The Post 9/11 GI Bill has provided funds for the education of 215,000 veterans in rural areas. Of these, 3,600 live in extremely rural areas. • Wounded Warrior Tax Credit - proposed as an incentive for hiring veterans w/ service connected disabilities