Pre-hospital and trauma care: The University of Alabama at Birmingham is Level 1 trauma center located in Birmingham, AL. Our TBI Model System begins with the Birmingham Regional Emergency Medical Services System (BREMSS) which is responsible for overall coordination in the pre-hospital emergency medical care system within six counties of the metropolitan area. Trauma patients are admitted to University Hospital, which is a 908-bed licensed healthcare facility. Recent completion of the North Pavilion has provided access to a state of the art emergency room, high-tech surgical suites that can accommodate robot-assisted surgery, and a helipad. In addition, the new nine-floor tower boasts imaging facilities, a 196-bed capacity intensive-care and acute-care unit, and additional support services. Patients with TBI in these settings are treated by both trauma surgeons and neurosurgeons. In the ICU, patients with TBI are treated according to the Guidelines for the Management of Severe Head Injury. Trauma care is coordinated through the UAB Center for Injury Sciences (CIS). CIS's mission is to provide a multi-disciplinary focus for the care of injured patients and for research related to both prevention and treatment of injuries. Continuity of care from trauma service to inpatient rehabilitation is facilitated by the close working relationship of the Physical Medicine and Rehabilitation consult team composed of clinical faculty and residents. This affiliation begins in the first days after trauma care through admission to rehabilitation.

Comprehensive rehabilitation: Comprehensive brain injury rehabilitation in the UAB TBI Model System is provided within the Department of Physical Medicine & Rehabilitation located at Spain Rehabilitation Center (SRC), which is located in the midst of the UAB Hospital complex. SRC presently has 54 beds in operation with 9 beds housed on a secure unit specifically designated for use by individuals with TBI. SRC is physically connected to other components of University Hospital via an enclosed walkway. All therapies for UAB Hospitals are housed at SRC. Admission to SRC is based on ability to tolerate (and preferably participate in) 3 hours of therapy (PT, OT, ST) a day and physical limitations that prevent independent ambulation for at least 150 ft. A viable discharge plan is expected to be in place prior to transfer. The typical duration of stay is about 3 weeks.

Post-Acute Services in Rehabilitation: The Outpatient PM&R clinic, located on first floor of SRC, includes EMG laboratories and houses the Spasticity Clinical Program. The Constraint Induced Therapy (CIT) Laboratory is also located at SRC. Also located in this building are outpatient services in physical therapy, occupational therapy, speech therapy, neuropsychology, and rehabilitation medicine. All patients discharged from the Brain Injury Unit are followed in the outpatient clinic until there are no additional medical or neuropsychology rehabilitation needs. Integrated PT, OT, ST, vocational and psychological services are provided. There is no formal neurobehavioral program in Alabama, although our physiatrists assist people with medication management and our neuropsychologist provides counseling as necessary. In the absence of a formal post-acute programs, alternative service delivery models have been developed. The Alabama Department of Rehabilitation Services (ADRS) provides services through the Interactive Community Based Model, which involves the interventions of ADRS in the homes of people with TBI following discharge from the hospital. The Alabama Head Injury Foundation (AHIF) also sponsors Service Coordinators to assist people with TBI and their families to identify and access services in their local communities.

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