Amputation and Polytrauma

Battlefield wounds which lead to amputation of a limb(s) require complex medical treatment; and patients require extensive medical care. War injuries of this magnitude may cause multiple physical injuries (polytrauma) where both physical and psychological symptoms are exhibited. Healthcare providers try to maximize the patient's independence, mobility, and quality of life. Treatment plans are therefore customized for each patient's rehabilitation and prosthetic needs.

Polytrauma care is given to veterans and returning service members with injuries to more than one physical region or organ system. These injuries may be life threatening, and may result in physical, cognitive, psychological, or psychosocial impairments and functional disability. Examples of polytrauma include:

Amputation

Clinical Guidance

• VA/DoD Clinical Practice Guideline for Rehabilitation of Lower-Limb Amputation, 2007
• VHA Handbook 1172.03, Amputation System of Care, 15 Aug 12 (This Veterans Health Administration (VHA) Handbook describes policies and procedures for the Amputation System of Care with the goal of providing optimal care and rehabilitation for Veterans and Servicemembers with amputations.)
• Resources for Wounded Warriors with Traumatic Amputation, Journal of Rehabilitation Research & Development Vol 47, No 4, 2010
• Care of the Combat Amputee, Borden Institute, 2009 (This book addresses all aspects of combat amputee care ranging from surgical techniques to long-term care, polytrauma and comorbidities such as traumatic brain injury and burns, pain management, psychological issues, physical and occupational therapy, VA benefits, prosthetics and adaptive technologies, sports and recreational opportunities, and return to duty and vocational rehabilitation.)
• Veterans Health Initiative:Traumatic Amputation and Prosthetics Independent Study Guide, May 02

DoD/VA Programs and Services

• Center for the Intrepid, San Antonio Military Medical Center (The threefold mission of the CFI is to provide rehabilitation for OIF/OEF casualties who have sustained amputation, burns, or functional limb loss; to provide education to healthcare professionals in the DoD and Department of Veterans Affairs on cutting edge rehabilitation modalities; and to promote research in the fields of orthopedics, prosthetics and physical/occupational rehabilitation. For further information, click here.)
• WRNMMC Department of Physical Medicine & Rehabilitation Service
• VA Center of Excellence for Limb Loss Prevention and Prosthetic Engineering
• Prosthetics: High Tech Support for Wounded Warriors
• Center of Excellence in the Mitigation, Treatment, and Rehabilitation of Traumatic Extremity injuries and Amputations
  • Report to Congress 18 Jan 12
  • Report to Congress 16 May 11
  • Report to Congress 30 May 09

Other Organizations and Services

• Amputee Coalition of America (ACA)
• Military in-Step (A publication of the ACA in partnership with the US Army Amputee Patient Care Program.)

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Blast-Related Injuries

Blast Injury

• DoD Blast Injury Research Program
• VA Polytrauma and Blast-Related Injuries (PT/BRI) Quality Enhancement Research Initiative (QUERI) (Its mission is to promote the successful rehabilitation, psychological adjustment and community re-integration of individuals who have sustained polytrauma (PT) and blast-related injuries.)
• Army Dismounted Complex Blast Injury Task Force Report, 18 Jun 11
• CDC Blast Injury Fact Sheets
• CDC Explosions and Blast Injuries: A Primer for Clinicians
• Medscape E-Medicine, Blast Injuries, 28 May 10

Burns

• United States Army Institute of Surgical Research (USAISR) Burn Center

Embedded Fragments

• DHCC Metal Fragments Web Page

Hearing Impairment

• Hearing Center of Excellence (HCE) (The DoD HCE's mission is to heighten readiness and continuously improve the health and quality of life of service members and veterans through advocacy and leadership in the development of initiatives focused on the prevention, diagnosis, mitigation, treatment, rehabilitation and research of hearing loss and auditory-vestibular injury.)

Traumatic Brain Injury (TBI)

• Defense Centers of Excellence For Psychological Health & Traumatic Brain Injury
• Defense and Veterans Brain Injury Center (DVBIC)
• DHCC TBI Web Page

Polytrauma Care

• VA Polytrauma System of Care

Visual Impairment

• Vision Center of Excellence (VCE) (The VCE) is the leading advocate for research and treatment for improved vision care and restorative innovations for service members.)
• VA Blind Rehabilitation Services (BRS) (The BRS supports blind and low vision Veterans and active duty Servicemembers in regaining their independence and quality of life to enable their successful integration into family and community life.)

Joint Trauma System

• U.S. Army Institute of Surgical Research Joint Trauma System (The Joint Trauma System (JTS) is an organized approach to providing improved trauma care across the continuum of the Levels of Care to trauma patients, especially in the battlefield environment.)
• Joint Trauma System Clinical Practice Guidelines

• Joint Theater Trauma System (JTTS) and Joint Theater Trauma Registry (JTTR) Information Brief to Defense Health Board, 14 Jul 10

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Related Links

• Army Office of The Surgeon General (OTSG) Rehabilitation & Reintegration Division (R2D) (R2D was established to institute Army-wide standards of care for all rehabilitation and transition of injured Soldiers, with diagnoses to include traumatic brain injury (TBI), amputations, polytrauma, vision and hearing impairments, burns, chronic and acute musculoskeletal injuries, and functional limitations related to combat stress.)

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