Pre-hospital and trauma care: NYC-EMS, the initial element of the NYTBIMS, provides emergency medical services in the five boroughs of NYC. Any person who meets a CNS trauma profile is transported to a Level I trauma center, one of which is Elmhurst Hospital Center (EHC) in Queens, the primary point of entrée into the NYTBIMS. Mount Sinai Hospital's (MSH) Level II trauma center, in Manhattan, also provides a portal for patients who do not have a recognized CNS profile or who are transported by other means than NYC-EMS. At EHC, acute care services are provided in a 12-bed surgical trauma intensive care unit, a 4-bed critical care area, and a 20-bed general neurosurgical unit. At MSH, acute care is provided in appropriate medical-surgical units.

Comprehensive rehabilitation: Rehabilitation services at EHC are provided in a 25-bed unit. MSH's 25-bed acute rehabilitation inpatient brain injury unit is the only program in New York City with CARF accreditation to provide specialized brain injury services. Dr. Steven Flanagan, NYTBIMS co-director, provides overall direction of TBI rehabilitation care at both MSH and EHC. This supports the integration of the brain injury rehabilitation program at EHC with that of MSH. MSH uses a Cognitive/Communication Track Program to enhance the delivery of care for patients with TBI, which maximizes therapy time and permits more challenging programming as patients progress in their recovery. All model system patients and their families are linked to peer support services while at either EHC or MSH. A TBI survivor/advocate supervises this program.

Post-Acute Services in Rehabilitation: The outpatient program is organized into three components: TBI clinics (EHC, MSH), outpatient rehabilitation services (EHC, MSH), and (at MSH) the Phase II Program. For patients discharged home from the hospital, the clinics serve as a mechanism for referrals for needed community services. Also, the clinics provide evaluation and services to patients who have been discharged from the ER but who continue to be symptomatic. At the time of either hospital discharge or the first clinic appointment, the need for outpatient rehab services is determined, with referrals made. The Phase II Program at MSH is a structured program to achieve maximum community integration. The NYTBIMS sponsors three support groups: a general support group, a women's support group and a writers' group. Subacute Rehabilitation Subacute rehabilitation is provided through two skilled nursing facilities (Park Terrace Care Center and Queens Nassau Nursing Home). The current TBI certified bed capacity is 20 for each facility. Specialized TBI programs at both facilities were developed under the supervision of a neuropsychologist and include diverse treatment tracks to suit the needs of a variety of patients. Monthly consultation on all NYTBIMS patients transferred to these facilities is provided by Dr. Flanagan, who is also medical director of Park Terrace.

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