Amputee Care and the Family CPT Brian D' Belnap, DO Medical Director Comprehensive Combat Casualty C

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Amputee Care and the Family CPT Brian D. Belnap,
DOMedical DirectorComprehensive Combat Casualty
Care CenterNaval Medical Center, San Diego15
March 2007
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Average Length Of Stay
CSH 1.8 Days LARMC 5.2 Days CONUS MEDCEN 41.7
Days
During Viet Nam the average time from Injury to
reaching the amputee center was 4 Weeks
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DoD Amputee Centers
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Battlefield Survival

• Forward surgical/resuscitation capabilities
• Advanced evacuation capabilities
• Body Armor
• Advanced surgical techniques
• Advances in antibiotic tx

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Geographic Distribution
Number of COMPO 1, COMPO 2 and COMPO 3 Soldiers
AMPUTEES from OIF and OEF by HOME STATE OF RECORD
(for National Guard and Reserve) or HOME
INSTALLATION STATE LOCATION (for Active Duty)
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Service Distribution Chart
4
6
64
247
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Age Distribution Chart
4
35
131
151
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Rank Distribution Chart
0.48
7.69
40.87
50.96
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Major Limb Amputations
May 2006
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Complex Medical/Surgical Rehabilitation Issues

• Brain Injury
• Spinal Cord Injury
• Fractures
• Facial Trauma
• Peripheral Nerve Injury
• Internal Organ Damage
• Pain Management
• Poor wound closure

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Complex Surgical Problems

• Amputee surgical procedures staged over lengthy
  evacuation chain at different treatment
  facilities
• Multiple, complex injuries
• Multiple amputations, bone fractures
• Wound healing

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Infections

• Dirty wounds
• Frequent returns to the OR
• washouts
• revisions
• Acinetobacter baumanii
• some sensitive and some resistant to abx

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Prevent/Treat Complications

• DVT/PE
• Increased Risk
• Asymptomatic
• Prophylaxis
• HO
• Healing
• Pain
• Prosthetic fitting
• Treatment

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Heterotopic Ossification
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Unique Psycho-Social Needs

• Adjustment to loss at young age
• Separation from unit/family
• Combat/deployment stress
• Duty status-AD, NG, Reserves
• MEB/PEB
• Social support system
• Premorbid socio-economic status

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Soldiers divorce rates up sharply By Gregg
Zoroya, USA TODAY, 7 June 2005

• Army Officers up 78
• Army Enlisted up 28, up 53 from 2000

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GOAL

• Provide the highest quality of care to our
  service men and women, who are willing to put
  their life in harms way.

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Vision
Through the collaboration of a interdisciplinary
team, we will provide world-renowned combat
casualty care, assisting our patients as they
return to the highest levels of physical,
spiritual, psychological and emotional function.
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Teamwork

• Prosthetics
• Psychiatric Consultation
• Social Work
• Peer Support
• Chaplain
• Nutrition
• YMCA
• Command Support
• Congress/OTSG
• PEBLO
• Public Affairs Office
• VA Counselors

• Patient
• Family
• Surgeons
• All subspecialties
• Physical Medicine Rehabilitation
• Anesthesia and Pain Management
• Case Management
• Nursing
• Physical Therapy
• Occupational Therapy
• TBI Team

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Incorporating the Family..
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• Family Participation in Rehab Process

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Vocational Rehab
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Vocational Rehab
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Return To Duty

• 2005 15/87 (17) Returned to duty
• 1995 2.3

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Recreational Therapy
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Social Context of Rehab

• Value of group therapy patients families
• Body/mind
• Social reintegration

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Peer Support

• Training available (ACA)
• Extremely valuable
• Patient, family
• Rehab Team

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Proper Disposition
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Other Lessons Learned

• Effective case management
• Partner with VA, Marine for Life, AW2, Safe
  Harbor, Military Severely Injured, and others
• Spouse/family support groups
• Preventive family/marriage counseling through
  family support services

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Thank You!