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AMSUS: How to care for warriors who used to be wounded

Navy Capt. Walter Greenhalgh (far right), National Intrepid Center of Excellence (NICoE) director, moderated a discussion on care after acute injuries during the “I Used to be a Wounded Warrior” session at the recent AMSUS (the Society of Federal Health Professionals) meeting near Washington, D.C. Joining him on the stage are (l-r) Rory Cooper, chair of the Department of Rehabilitation Science & Technology, and professor of Bioengineering, Physical Medicine & Rehab, and Orthopedic Surgery at the University of Pittsburgh; retired Army Col. Greg Gadson; Larry Miller, retired U.S. Navy physician assistant and now with the James A. Haley Veterans' Hospital in Tampa, Florida; and Dr. Paul Pasquina, retired Army doctor and currently chair of Physical Medicine and Rehabilitation at the Uniformed Services University of the Health Sciences (USU) in Bethesda, Maryland. Navy Capt. Walter Greenhalgh (far right), National Intrepid Center of Excellence (NICoE) director, moderated a discussion on care after acute injuries during the “I Used to be a Wounded Warrior” session at the recent AMSUS (the Society of Federal Health Professionals) meeting near Washington, D.C. Joining him on the stage are (l-r) Rory Cooper, chair of the Department of Rehabilitation Science & Technology, and professor of Bioengineering, Physical Medicine & Rehab, and Orthopedic Surgery at the University of Pittsburgh; retired Army Col. Greg Gadson; Larry Miller, retired U.S. Navy physician assistant and now with the James A. Haley Veterans' Hospital in Tampa, Florida; and Dr. Paul Pasquina, retired Army doctor and currently chair of Physical Medicine and Rehabilitation at the Uniformed Services University of the Health Sciences (USU) in Bethesda, Maryland.

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For many back home from the battlefield, the wounds are right there in the open: the amputated leg, the mangled hand. But some of those who were injured don’t still see themselves as wounded warriors.

“I was a warrior, and I was wounded, but I’m not continuing to be wounded,” said retired Army Col. Greg Gadson, who lost both legs to an improvised explosive device in Iraq in 2007. “I’ve been blessed to really be part of this whole equation (of the Military Health System, Veterans Health Administration patient, and member of the civilian community) as a soldier who has moved on after his injuries and transition from the military.”

Five years after his injuries, Gadson became the first soldier with two amputations to take over as a garrison commander of a major installation, as well as later making his mark as a movie star and motivational speaker. He was part of the “I Used to be a Wounded Warrior” session during the recent AMSUS (the Society of Federal Health Professionals) meeting near Washington, D.C. Navy Capt. Walter Greenhalgh, National Intrepid Center of Excellence (NICoE) director, moderated the discussion, which brought Gadson and representatives from military hospitals, the Department of Veterans Affairs (VA) and civilian academia to the stage. They discussed how to help wounded service members move beyond their injuries and resume as normal a life as possible.

Referring to NICoE’s network of nine centers across the Military Health System, Greenhalgh highlighted a spirit of cooperation within military hospitals and clinics.

“There are some unique capabilities from the local facilities. But there are some commonalities as well,” he said. “Leaders of our intrepid centers came together to meet with us at NICoE and nearby Walter Reed National Military Medical Center in Bethesda to discuss best practices and standardize care, data collection, analysis and outcome interests.”

Larry Miller is a retired U.S. Navy physician assistant and now with the James A. Haley Veterans' Hospital in Tampa, Florida. He said the VA has a great relationship with NICoE and provides an excellent example of the DoD and VA working together.

“We’re synergistic. We share patients. We share data, and I think that’s a fantastic way to show we’re doing DoD/VA collaboration in an effective format,” said Miller, pointing to the work his department has done on sleep and pain issues in conjunction with military health care providers and a robust outpatient program similar to that of NICoE. “When they leave at the end of the treatment program, 100 percent of the people feel like they’re emotionally functioning better, they’re sleeping better, their cognitive abilities are better, and their physical abilities are better.”

Dr. Paul Pasquina, a retired Army doctor and current chair of Physical Medicine and Rehabilitation at the Uniformed Services University of the Health Sciences (USU) in Bethesda, Maryland, said the handoff from military to VA sometimes doesn’t go as smoothly as hoped. That’s why the military is working rehabilitation, usually a domain of the VA, early into the treatment of patients with acute injuries.

“We can’t wait until all medical issues are taken care of before we start addressing the rehabilitation and behavioral health issues,” said Pasquina. “You have to move all that stuff into warrior care and throughout.”

Rory Cooper is the chair of the University of Pittsburgh’s Department of Rehabilitation Science & Technology, and professor of Bioengineering, Physical Medicine & Rehab, and Orthopedic Surgery at the school. He added to Pasquina’s call for making sure doctors and providers, in the military and civilian medical world, keep up on skills learned. Part of that is making teachers out of military doctors who have seen combat medicine.

“The civilian sector is not yet benefiting from the lessons learned by the military and VA in the last 15 years, and we have learned a tremendous amount [about trauma medicine],” said Cooper. “Those lessons need to be institutionalized throughout the United States.”

The diverse group assembled for this session agreed all need to focus on a complete continuum of care before and after injury. And Gadson said that care for those severely wounded, such as himself, continues long after they leave the hospital.

“The responsibility is more than saving a life and giving somebody discharge papers,” said Gadson. “We have a great responsibility to the nation to make sure our veterans and their families are recognized and cared for after their sacrifice.”

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