Levels of Blast Injury • Primary blast injury is related to the shock-wave overpressure and underpressure, • Secondary blast injury results from blast associated fragments or shrapnel • Tertiary blast injury occurs secondary to falling debris or throwing of the dismounted soldier or vehicle. • Quaternary blast injury develops from a variety of physical processes associated with explosive detonation such as thermal, toxic detonation products. • Quinaryeffects are sometimes included and refer to the environmental hazard remaining after an explosive detonation. Moore and Jaffee (2011)
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.
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.
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.
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.
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
Vocational Solutions • 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