Pre-hospital and trauma care: The Virginia Commonwealth University Medical Center (VCUMC) is one of five Level I Trauma Centers in the Commonwealth of Virginia and the only in one central Virginia. State-of-the-art care is available to all patients, regardless of financial resources. As prearranged with Emergency Medical Services, all persons with severe TBI's (Glasgow Coma Scale score less than 9) incurred within central Virginia are transported by ground or air to VCUMC. A helipad is located at the hospital to permit rapid evacuation from remote sites. The VCUMC ER maintains reserved spaces for those individuals admitted with TBI. Admitted patients are transferred to the Neuroscience Intensive Care Unit. Any patient admitted for TBI, regardless of other associated injuries, must be seen by the Neurosurgical Service as soon as possible after arrival to the Emergency Room. The Neuroscience Intensive Care Unit (NSICU) is one of five specialized intensive care units within VCUMC. All NSICU patients are seen by the Brain Injury Rehabilitation Consultation Service, within 24-48 hours of admission. The physiatrist and staff round twice per week with the Neurosurgical Brain Injury Team.

Comprehensive rehabilitation: The Neurologic Recovery Care Unit is a 24-bed subacute unit jointly operated by VCUMC and HCA-Columbia's Retreat Hospital. The purpose of this program is to provide subacute rehabilitation services for low-functioning patients. The Neurologic Recovery Care Unit provides intensive neuromedical services with a strong physiatric and nursing emphasis. Patients in this program are not yet ready for acute inpatient rehabilitation services due to their level of neurologic function or their inability to tolerate a more intensive therapeutic setting. Once medically stable, appropriate patients are transferred to the 15-bed Brain Injury Rehabilitation Program at VCUMC. The program was established as a distinct unit within the 50-year-old Rehabilitation and Research Center at VCUMC in 1983.

Post-Acute Services in Rehabilitation: Post-discharge patients are evaluated and treatment is coordinated by a physiatrist in the Brain Injury Clinic. Nursing and social work services work closely with the physiatrist to address case management issues. In addition, the Neuropsychology and Rehabilitation Psychology service provides psychotherapy and substance abuse counseling to individuals and family members who are having difficulty coping with changes arising from the TBI. Vocational services are provided through the RRTC on Workplace Supports. In order to provide maximum intensity of services in the least restrictive environment, the VCU Brain Injury Program developed a partnership with a day rehabilitation program in the community, Sheltering Arms Rehabilitation Hospital. This program (under the direction of a VCUMC physiatrist) provides a full day of interdisciplinary rehabilitation, as well as transportation to and from the program. There are a number of other unique services that VCUMC offers individuals with TBI. The TBI Model System includes a family education and support intervention program, an acute care cognitive intervention program, diagnosis and treatment of depression, and regularly scheduled educational workshops for individuals with TBI and their family members. Additionally, VCUMC staff collaborate with Tree of Life Transitional Living Services (a six-bed post-acute rehabilitation program in a community-based, accessible home setting) in providing educational opportunities for individuals with TBI. Other collaborations include work with the state Department of Rehabilitative Services (VCU TBIMS staff have participated in program development and counselor training programs) and the Brain Injury Association of Virginia (educational materials are shared; VCU TBIMS staff have directed regular family support groups for the state organization and participate in family education conferences and workshops; and psychology post-doctoral fellows from VCUMC lead a BIAV-sponsored support group).

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