By Kirk FradyNovember 15, 2017
FORT SAM HOUSTON, TEXAS (Nov. 15, 2017) - As the DoD lead for the Extremity Trauma and Amputation Center of Excellence (EACE), the U.S. Army Medical Command (MEDCOM) leads the way when it comes to the mitigation, treatment and rehabilitation of traumatic extremity injuries and amputations.
EACE is the primary advocate for research and treatment of Department of Defense (DoD) and Department of Veterans Affairs (VA) patients with extremity trauma and amputation. Working with TRICARE, the Military Health System, VA and other Centers of Excellence, EACE leads the effort to enhance collaboration between DoD and VA amputation care providers and conducts scientific research to minimize the effects of traumatic extremity injuries and improve clinical outcomes.
"During recent conflicts, over 1,700 wounded/injured service members have sustained traumatic amputations. Our mission at the EACE is to ensure they receive the finest clinical care available, while conducting clinically-relevant research to improve care for current and future wounded service members. We believe that our interdisciplinary-team approach to care and clinically-focused research is improving clinical care and long-term functional outcomes in ways that truly matter to our patients," said Mr. John Shero, EACE Executive Director. He added, "The lessons learned and clinical skills developed over the past 16 years of conflict will help to inform and improve clinical care for amputations across the country and around the world."
The mission at EACE is to implement a comprehensive plan and strategy, to conduct clinically relevant research, foster collaboration and build partnerships across the multidisciplinary international, federal and academic networks to optimize the quality of life of service members and veterans.
In 2001, retired Lt. Gen. James Peake, M.D., then Army Surgeon General, directed the assessment of the Army Medical Department's ability to care for large populations of combat amputees. That same year an amputee care center was established at Walter Reed Army Medical Center. In 2005, Brooke Army Medical Center began caring for amputees. In 2007, three DoD Advanced Rehabilitation Centers were established to rehabilitate military amputees at Walter Reed, Brooke Army Medical Center, and Naval Medical Center San Diego. The VA established an Amputation System of Care across the United States with Regional Amputation Centers and Polytrauma Amputation Network Sites. Significant advances in the treatment and rehabilitation of extremity trauma and amputee patients resulted from these efforts.
In 2009, the EACE was legislated by Congress as a collaborative organization to enhance partnerships between the DoD and VA as well as institutions of higher education and other appropriate public and private entities.
Unique to the EACE, is a Congressional mandate under the Duncan Hunter National Defense Authorization Act to, "conduct research to develop scientific information aimed at saving injured extremities, avoiding amputations, and preserving and restoring the function of injured extremities." The EACE will optimize multi-disciplinary team management strategies, with a focus on conducting scientific research to improve the clinical outcomes of its patients as they return to the highest possible level of physical, psychological, and emotional function.
RESPONSIBILITIES / FUNCTIONS:
The EACE is broken down into four major areas: Research and Surveillance; Clinical Affairs; Global Health Engagement; and Clinical Informatics.
Research and Surveillance:
The EACE Research and Surveillance Division supports the mission of the EACE by identifying relevant research gap areas, directing and executing a patient-centric intramural research program within the Advanced Rehabilitation Centers (ARCs), and providing coordination and oversight for extramural research initiatives approved to conduct within the Military Treatment Facilities (MTFs). The EACE also works closely with Veteran's Affairs (VA), Medical Research and Materiel Command (MRMC), Defense Advanced Research Projects Agency (DARPA), and other Centers of Excellence (CoEs) to assure research outcomes from intramural and extramural efforts are translated to clinical practice.
Clinical Affairs serves to foster the ultimate goal of full restoration of normal human function for beneficiaries with extremity trauma and amputation. Attaining this goal will likely take decades to achieve. In pursuit of that goal, DoD will focus on individualized, optimized functional outcomes that are driven by patient goals and supported through a whole person, transdisciplinary healthcare team approach.
Global Health Engagements:
The EACE Global Health Engagement Division (GHED) was created to implement a comprehensive plan and strategy for the Department of Defense (DoD) to mitigate, treat, and rehabilitate traumatic extremity injuries by collaborating globally with partner nations, institutions of higher education and other appropriate agencies.
The GHED mission supports Geographic Combatant Commands (GCC) during interactions between individuals or elements of the DoD and those of a Partner Nation's (PN's) armed forces or civilian authorities. This is done in conjunction with other U.S. Government departments and agencies to build trust and confidence, share information, coordinate mutual activities, maintain influence, and achieve interoperability in amputee and extremity trauma related activities that support GCC Theater Security Cooperation and Theater Campaign Plans.
The Clinical Informatics and Technology Division uses clinical information, healthcare data systems, and modern technology to support clinical care and research efforts designed to improve the health outcomes of service members and veterans who have experienced traumatic extremity injuries and amputations. The Clinical Informatics and Technology Division builds upon the Federated Registry Data Warehouse through linkages with existing data systems such as the DoD Trauma Registry, Military Orthopedic Trauma Registry, and the VA Amputation System of Care Outcome Repository.
Aligning to Electronic Health Records (EHR) will identify individuals, demographics, and practices to study variations among and effectiveness of acute and rehabilitation care practices, prosthetic technology and services, incidence of complications, mitigation of secondary disabilities, patient outcomes and quality of life.
• Over the past 15 plus years, there have been 1,718 conflict-related amputee service members. 533 of these (nearly one in three) involved multiple-limb amputations.
• Almost two-thirds of conflict-related amputees were Army Soldiers.
• Over 90 percent of the conflict-related amputations were caused by blast injuries, which cause very complex injury patterns.
• A total of 429 conflict and non-conflict amputees elected to remain on active duty. This is a direct reflection of the high level of functionality achieved through today's interdisciplinary teams and their approach to rehabilitation. By comparison, there were very few amputees from the Vietnam era who were allowed to remain on active duty.
• Of the 429 amputees who remain on active duty, 85 of them deployed after sustaining an amputation (almost one in five).
It is through joint partnership initiatives like the EACE that ensure military health professionals will continue to raise the bar in the development and implementation of a new normal where service members who have experienced extremity trauma can achieve their highest level of function and enjoy a better quality of life.