Brain injury: society's new dilemma.

• Author: Wasco, James E.

While medical technology can keep victims of severe head trauma alive, the costs for their families--both financial and emotional--are overwhelming.

TWO DECADES AGO, the U.S. had no problem dealing with survivors of severe head injury--there simply weren't many. Hundreds of thousands of people suffered serious brain trauma each year, but the crisis tended to be short-lived. The great majority died during the first few hours, days, or weeks after the motor vehicle accident, fall, or assault.

In the 1970s, however, the Federal government developed and funded important national programs to attack the "hidden epidemic" of trauma. A Department of Emergency Medical Services was established in what is now the Department of Health and Human Services and led the effort to increase access to high-quality emergency treatment. Emergency 911 lines were set up. Ambulance and helivac services were expanded and staffed by trained technicians with the knowledge and equipment to bring emergency room techniques to the street. Emergency departments in hospitals were upgraded and a national network of trauma centers established. At the same time, technological advances such as CT scans and microsurgery made possible rapid diagnosis and sophisticated treatment for the patient with neurological injury.

Because of this multi-billion-dollar program, the number of people who survived severe trauma and brain injury increased enormously. However, they often survived with disabilities, leaving the nation's health care system with yet another challenge--an entire new patient population in need of long-term treatment and rehabilitation from their injuries.

Of the 500,000 people who are hospitalized in this country each year because of head injury, 70-90,000 survive the initial trauma with debilitating loss of function. Swallowing and feeding disorders can make adequate nutrition difficult. Partial or complete paralysis is common, and some individuals need ventilator care to breathe. Bedridden survivors are at risk for decubitus ulcers, as well as pulmonary and urinary infections. In addition to these physical complications, others suffer extremely difficult behavioral and psychological problems, including loss of memory, poor ability to control temper, erratic judgment, sexual dysfunction, and cognitive deficits.

The government programs of the 1970s were a great success in saving people's lives. Unfortunately for many survivors, no comparable national programs have been...