John Fergason, CPO
Fort Sam Houston, TX
Brooke Army Medical Center is home to one of two specialized Amputee Care Centers
operated by the Department of Defense. The Center was opened in January 2005 in
response to the rising need for treatment of active duty service members with traumatic
limb loss. Services are provided primarily to Active Duty patients who have sustained
amputations due to trauma. Service Members from units west of the Mississippi River
and Service Members concurrently treated by the ISR Burn Center are treated at BAMC,
while those from units east of the Mississippi receive treatment at WRAMC. Services are
provided to other adult patient beneficiary categories on a space available basis.
The complexity of cases typically treated are received through the evacuation chain from
theater, or are referred from the Trauma, Burn, or Orthopaedic Surgery services, primary
care providers, or regional hospitals. Each patient that is seen the Amputee Care Center is
evaluated at minimum by practitioners in Orthopaedic Surgery, Physiatry, Prosthetics,
Physical Therapy, Occupational Therapy, Behavioral Medicine, and Case
Management/Social Work. Additional evaluations are obtained as needed from other
disciplines such as Nutrition, Pain Management, Audiology, Neurology, and Veterans
Benefits. This comprehensive evaluation is then used to formulate a care plan and
treatment goals with the patient. The care plan is reviewed frequently in
multidisciplinary meetings and adjusted to maximize physical and emotional recovery.
Inpatients that arrive having already had an amputation are evaluated early in their
hospitalization, while still on the Trauma, Burn, or Orthopaedic Surgery service. These
patients frequently have multiple injuries in addition to limb loss and may remain on the
primary service for some time prior to transfer to the Inpatient Amputee Service. In those
cases in which an amputation is anticipated due to the severity of the extremity injury, the
patient is evaluated preoperatively. Patients arriving as inpatients who do not have acute
active surgical issues are admitted directly to the Inpatient Amputee Service. Care for
residual issues outside the Amputee Service scope of practice is obtained by consultation
to the appropriate service(s). Once a patient’s acute surgical issues are resolved, the
patient is transferred to the Inpatient Amputee Service by consultation from the attending
surgeon to the Physiatrist. Frequently, the patient may transition to outpatient treatment
directly with appropriate assistive devices and accommodations.
Once a patient enters the outpatient program one of the early goals is re-integration into
the community as soon as possible. The wide range of assistive devices, the availability
of ADA accessible barracks room, and family support in Guest House or Fisher House
accommodations make transition to outpatient status possible early in the treatment
course for many service members. For Active Duty outpatients evaluations take place at
the weekly Amputee Clinic. A plan of care is then formulated and implemented. Non-
Active Duty patients referred solely for prosthetic issues are evaluated by appointment
with the Prosthetist on a space available basis at the Prosthetic/Orthotic Clinic.
Evaluation of this patient population in Amputee Clinic to formulate rehabilitation plans
is restricted due to mission requirements, but sometimes possible
As a multidisciplinary service, a broad range of support services are provided by or,
coordinated through, the Amputee Service. Direct support for the amputee includes
advanced techniques in limb-loss surgery, physical medicine and rehabilitation, physical
and occupational therapy, prosthetic and orthotic services, behavioral health services in
individual and group settings, case management and social work assistance with
coordination of care. There is assistance available for family housing and travel, durable
medical equipment and rehabilitative and recreational activities to enhance quality of life
and return of function.
Specific fitting protocols for the lower extremity will be discussed within the context of
discharge goals and active duty retention.
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