Proceedings of the AMSUS Summit for Federal and Civilian Orthopedic Rehabilitation Programs.

Abstract

INTRODUCTION In its 2015 report, “Sustainment and Advancement of Amputee Care,” the Defense Health Board (DHB) found that the interdisciplinary team approach to the treatment of service members with traumatic limb injuries has resulted in unprecedented innovation in amputee care and technology. Over the past 13 years, more than 1,640 members of the U.S. Armed Forces have suffered a traumatic injury requiring a limb amputation as a result of the five operations in Iraq and Afghanistan since 2001. The good news is that more of these soldiers have survived than in the past, in part because of better equipment, improved battlefield first-aid, and more sophisticated surgical care. Despite facing more severe orthopedic injuries from high-velocity weapons and improvised explosive devices, this unique cohort has achieved higher levels of function than those from past battles. In 2008, an above-the-knee amputee, SFC Daniel Metzdorf, became the first and only Wounded Warrior to graduate from the Golden Knights, the elite Army parachute team. Service members with double amputations walk and run using stateof-the-art prosthetic limbs, while hundreds of amputees have returned to active duty. Among active-duty members who lost limbs during the recent conflicts, 71 have redeployed. These wounded service members also are living productive civilian lives, running marathons, competing in obstacle races, and raising their families while adapting to the “New Normal” of their lives. These improved outcomes can be attributed in part to advances in medical and surgical infrastructure across the continuum of amputee care. Groundbreaking technologies and approaches to patient care developed by the Department of Defense (DoD) and Department of Veterans Affairs (VA) have dramatically improved outcomes for those with traumatic limb loss, as well as for their overall quality of life. The DHB report noted, “It is apparent that DoD is leading the Nation and the world in extremity trauma and amputee science and care through its infrastructure, systems, and approach.” But in order to continue providing this level of excellence, collaborations across military, academic, and civilian institutions need to be further developed and expanded, even as the conflicts overseas wind down. This 134-page report provided the needed foundation to launch a robust conference discussing both the current state of orthopedic rehabilitation services for service members and civilians with extremity trauma and amputation as well as the needs for the future. Representatives from the DoD, VA, and civilian community came together during the AMSUS Annual Continuing Education Meeting in San Antonio, Texas, to talk about how military, academic, civilian, and industry partners can work together to help military amputees recover and reach their full potential. Discussions focused on how the DoD/VA can best address the lifelong needs of the amputee population, including those who have been injured during these recent conflicts as well as service members who may suffer traumatic limb injuries in future conflicts. Three sponsored events highlighted the need for continued collaboration among orthopedic rehabilitation teams. The first, “WARfighters Receiving Innovative Orthopedic Rehabilitation (WARRIOR) Symposium: Research and Treatment of Patients with Extremity Trauma and Amputation,” discussed the state-of-the-art programs that currently exist and how they use research to impact amputee care in the federal and civilian communities. A midweek breakfast program sponsored by the Mayo Clinic featured SFC Metzdorf sharing his own experiences as a Wounded Warrior to show the impact of integrated clinical care with a holistic, patient-centered approach. Finally, an end-of-week panel featuring officials from the DoD, VA, and National Institutes of Health (NIH), along with industry experts, discussed ways of sustaining this high-level amputee care within the framework of the “New Normal.” These three events were sponsored by an interdisciplinary group that highlights the power of an integrative model: the Bridging Advanced Developments for Exceptional Rehabilitation (BADER) Consortium, a DoD-funded cooperative agreement awarded to the University of Delaware, the Mayo Clinic, the American Orthotic & Prosthetic Association, the Orthotic and Prosthetic Group of America, and the American Academy of Orthotists and Prosthetists. One of the goals of the group was to bring these vested groups together to see what can be accomplished through collaboration. As such, the BADER Consortium supported the travel of 37 individuals to the AMSUS conference. The overarching theme of the week’s events focused on the need for outcomes research to better evaluate patient care, encourage technology development, and facilitate clinical approaches. To that end, speakers at the three events overwhelmingly supported a DHB recommendation to develop and maintain a centralized registry of amputees to better understand *BADER Consortium, University of Delaware, 540 S. College Avenue, Newark, DE 19713. †Brownian Consulting LLC, 104 Blueberry Hill Drive, Hanover, NH 03755. ‡Thought Leadership and Innovation Foundation, 16775 Whirlaway Court, Leesburg, VA 20176. doi: 10.7205/MILMED-D-15-00580