The fall of amputations worries military doctors who forget how to treat them

Doctors do not perform as many combat related amputations these days.

But this good news for service members has a potential drawback: military health professionals may forget how to treat patients with a missing limb. That happened after the Vietnam War.

"Over time, some skills could atrophy," said Jason Etchegaray, lead author of a new report from RAND Corporation. To prevent this from happening, the report presents a series of recommendations for the military medical community to keep their skills up-to-date.

Through interviews with providers, patients and their families, as well as with the contribution of experts in the field, researchers identified a set of core competencies that health professionals need to deal with. effectively amputees. These range from technical expertise to bedside patients.

"I think it's very important because we do not know what the next war will look like and we do not know when that will happen," Etchegaray said.

The Center for Excellence in the Military Health System for Injuries and Amputations, or EACE, commissioned the study and plans to use RAND's recommendations as a starting point for future training of physicians, physical therapists, psychiatrists, prosthetists and other people working with amputees throughout the rehabilitation process. .

"We did not want to repeat what happened after the conflict in Vietnam, where the capacity and skills in the management of amputees were gradually lost, then we had to relearn them again," said John Shero, director of EACE. "We want to ensure that our victims in the future receive at least as good (if not better) (treatment) from this future conflict that our wounded warriors have received and received in recent years."

For nearly two decades since September 11, the Defense Department has treated 1,724 severely amputee patients of one member following an injury during a deployment, Shero said.

The report indicates that the number of combat-related amputations has declined sharply since 2011, when the number of amputations peaked at 260. There were three in 2018.

Patients are treated primarily at the Walter Reed National Military Medical Center in Maryland, Brooke Military Medical Center in San Antonio, and San Diego Naval Medical Center, which have treatment centers specifically designed for amputees.

These centers take a multidisciplinary approach to treating patients, requiring regular meetings between health care providers covering a variety of services that treat the same patient – something you do not usually see in civilian settings, Shero said.

The six core competencies, or "core competencies," described in the report are patient-centered care, evidence-based practice, professional behavior, patient and family education, cultural awareness and team work.

Stuart Campbell, Head of Global Engagement for Health at EACE, said the center knew its facilities treated amputees well, but the RAND report helps define what it looks like on the ground. ground.

EACE will use these results to establish a list of the key KSAs (knowledge, skills and abilities) required for each medical position in this space, which will eventually be transformed into learning objectives and implemented in modules of medical training as they are completed.