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Alabama rehabilitation officials say traumatic brain injury is widespread among first responders, urge screening and supervisor training
Summary
The Alabama Department of Rehabilitation Services reported FY25 registry counts showing 9,188 brain/spinal injuries and an estimated 102,000 Alabamians living with brain injury; ADRS urged TBI screening, confidentiality, expanded TBI centers and supervisor training to reduce stigma for first responders.
April Turner, the Alabama Department of Rehabilitation Services’ state brain injury coordinator, told the Joint Interim Committees that traumatic brain injury (TBI) is a chronic, often invisible condition with wide-ranging consequences and strong overlap with PTSD among veterans and first responders.
“TBI is a blunt force trauma to the head that is caused by an external force, such as a fall, blast, or MVA,” Turner said while outlining national classification and Alabama’s system of care. She described TBI as distinct from PTSD but readily comorbid: both can present with cognitive, mood and sleep symptoms.
Turner cited FY25 registry data showing 9,188 Alabamians had a brain or spinal cord injury in one year, with 3,611 classified as mild and 5,077 moderate to severe; she said about 102,000 Alabamians currently live with a brain injury. Turner estimated 40,000–50,000 first responders are exposed to repetitive head trauma annually in Alabama and said firefighters and law‑enforcement officers frequently report multiple lifetime head injuries.
She summarized comorbid risks: increased rates of PTSD, depression, anxiety, substance use disorder and suicide risk after TBI, and medication sensitivity that can complicate psychiatric treatment. Citing a longitudinal Brenner study of deployed soldiers, she said TBI was associated with higher rates of alcohol‑use disorder and mood disorders among veterans.
Turner described Alabama’s TBI navigation system and helpline that provides screening, referral, care coordination and training. She said ADRS has expanded free TBI services to veterans, Guard members and long‑term recovery clients and is implementing a TBI screener in the Alabama National Guard. Turner listed planned TBI centers in Huntsville, Birmingham, Opelika, Dothan and Mobile and stressed that services are confidential: “If they walk in the door to one of these centers or clinics, it is confidential. It does not go on their record.”
Committee members raised concerns about workplace disclosure and job security when employees seek care. Turner and other presenters recommended supervisor training and leadership education through professional organizations so employers can recognize trauma, reduce stigma and accommodate needed care under applicable disability protections.
Turner urged the committee to connect existing TBI programs with first‑responder organizations, expand specialized TBI training, and integrate TBI screening into first‑responder systems of care. The committee directed staff to incorporate these recommendations into their report to the Legislature.
