Pre-hospital and trauma care: Harborview Medical Center (HMC), as part of University of Washington Medicine (UWMedicine), is the leader in providing trauma care in Washington State and the Northwest U.S. Pre-hospital care is coordinated from HMC, the only Level I Trauma Center in the four-state NW region. Washington State has a coordinated trauma system through which trauma patients are evaluated in hospitals throughout the state, and transported by ground or air to HMC, if appropriate. The current national model of pre-hospital emergency medical response was started in Seattle in 1969 with the founding of Medic One, operating out of HMC and regional fire stations. Pre-hospital services were expanded in 1982 with the development of Airlift Northwest, which transports about 3000 patients a year. When patients arrive at HMC, they are evaluated and treated in the Emergency Department with 50,000 patient visits a year.

Comprehensive rehabilitation: Between 80 and 90 new people with TBI are admitted to inpatient rehabilitation at UW each year. Inpatient Rehabilitation Services for individuals with TBI are provided at HMC and University of Washington Medical Center (UWMC) located within 3 miles of each other. These units consist of a total of 49 inpatient rehabilitation beds. UW Rehabilitation Medicine has been rated among the top five rehabilitation programs in the United States since 1991. UWMedicine hospitals are accredited by JCAHO, and the inpatient rehabilitation units are jointly CARF accredited and designated by Washington State as Level I Trauma Rehabilitation Centers. Inpatients with TBI have full and immediate access to state-of-the-art medical, diagnostic, and consultative services, beginning in the ICU and acute medical/surgical services and transitioning to outpatient management. Approximately 30 people per year with TBI are discharged from HMC to the affiliated subacute rehabilitation facility at Seattle Medical and Rehabilitation Center.

Post-Acute Services in Rehabilitation: Outpatient rehabilitation services are usually provided through our system (central Seattle, (HMC), north Seattle (UWMC), and at Evergreen Head Injury Rehabilitation Program (HIRE) on the Eastside) but strong community ties to other states that form the WWAMI Consortium (Wyoming, Alaska, Montana, and Idaho) and rural areas allow for close interaction with local care providers. Formal means of consultation (MEDCON Toll-Free number for consultation) and facilities for teleconferencing allow readily available interaction with rural providers. Our outpatient program services are jointly directed by physiatrists and neuropsychologists. In addition to the usual integrated physical, occupational, and speech therapy services, HMC has a TBI education group and UWMC has both cognitive therapy and psychotherapy groups. Most patients also receive vocational services or are enrolled in a job site or volunteer position on the University campus. The UW TBI Model System has formed a close working relationship with the Washington State TBI Implementation Advisory Board (funded by HRSA) and has jointly produced three statewide live videoconferences on TBI.

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