Traumatic Extremity Injuries and Amputation Center of Excellence (EACE)

DoD TF on the Care, Management, and Transition of Recovering Wounded, Ill, and Injured Members of the Armed Forces
18 May 2011

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PURPOSE: To provide information on the Traumatic Extremity Injury and Amputation Center of Excellence (EACE)

1. 2. 3. 4.

What is the status of the EACE Who are the customers of the EACE How well utilized is the EACE What prevents higher utilization

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Status of EACE
Decision Paper to place the Headquarters in San Antonio,
Texas is awaiting concurrence from ASD(HA) Hiring of staff is awaiting concurrence of location Budget for $5.5M/year is in the FY12-16 POM All requirements of P.L. 110-417 October 14, 2008, Sec 723 (c) are being met by the Military Health Care System and the Veterans Administration

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Metrics for Extremity trauma and Amputation

Published VA/DoD Clinical Practice Guidelines for
Rehabilitation of Lower Limb Amputation version 1.0 2007 Published The next Step, The Rehabilitation Journey After Lower Limb Amputation VA/DoD Joint Patient Education Book Published Textbooks of Military Medicine, Care of the Combat Amputee 2009 DoD, VA, and Civilian collaborative effort Three Centers developed within DoD
Military Advanced Training Center (MATC) Washington, DC Center for the Intrepid (CFI) San Antonio, TX Complex and Combat Casualty Care Center (C5) San Diego, CA

Seven VA Regional Amputee Patient Care Centers (RACs)

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DoD Military Amputee Research Program - A Congressionally-Directed Program -

$ (M)

No research funding provided beyond FY 07

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Priority #1. Advance Amputee Technologies (extramural effort guided by clinical experts) Ruggedized C-leg for use in deployed environments
Water/sand resistant Responsive to uneven terrain, stairs, backward walking Currently in Use Prototype powered ankle prosthetic devices for running (SPARKy) and endurance walking (I-Walk) Advanced dynamic limb-socket interface technologies Currently in Use Infection prevention mechanisms for osseointegration
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Priority #2. Establish Intramural Research Infrastructure

BAMC / Center for the Intrepid (opened January 2007)

17 full-time research personnel 35 research protocols (10 completed data collection) 7 peer-reviewed manuscripts, 5 submitted and under review

WRAMC / Military Advanced Training Center (opened June 2008)

9 full-time research personnel 30 research protocols (8 completed data collection) 16 peer-reviewed manuscripts Established laboratory affiliated with NIH to pursue HO studies

Naval Medical Center San Diego / C5 (opened X) 3 full-time research personnel (non-MARP funded) Leveraged with Naval Health Research Center for CAREN studies

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Priority #3. Develop High-Level Functional Outcome Metrics

CHAMP Study Developed and established normative data for highlevel functional outcomes assessment battery for use in clinical assessment of patients with amputation

Developed and established normative data for CAREN Performance

Assessment Battery - established multi-task military-relevant functional outcomes metrics for use in assessing return-to-duty status following injury utilizing CAREN system

Developed and established laboratory-based advanced-task Gait Lab

Assessment Battery instrumented ambulation over uneven terrain (rocks, uneven surfaces), slopes, and stairs

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Priority #4. Link with Intra- and Extramural Partners in Academia, VA, DARPA, and Industry to Leverage with Existing Efforts
Veterans Administration Research Program DEKA Arm Study CFI was first DoD test site for DEKA prosthetic
arm (part of $100M DARPA Advanced Upper Extremity Prosthetics effort) Community Reintegration Instrument (CRIS) CFI was test site for validation of community reintegration instrument developed by Dr. Linda Resnik, Providence VA

Industry Ossur, Iwalk, Ottobock Functional assessment of new technologies within military
patient population vital

Academia - University of Iowa, Arizona State University, MIT,

Northwestern University, Oak Ridge National Labs

Military Army-Baylor University, Army Research Laboratories,

USARIEM
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Priority #5. Become World Leader for CARENbased Amputee (and Concussion) Rehabilitation Amputee Gait Training Using Virtual Research
Reality and Real-Time Feedback (improvements after 3-week intervention) Effect of Visual Field and Platform Perturbations on Gait Stability Established multi-task military-relevant functional outcomes metrics for use in assessing return-to-duty status following injury Located at CFI, MATC, NICoE, and NHRC

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Who are the Customers of the EACE

Recovering warriors with limb loss (approximately 1,200) Those with limb threatening severe extremity injury Service veterans eligible for care through the Veterans
Health Administration with limb trauma or disease threatening or resulting in limb loss All individuals with severe extremity trauma and limb loss that will benefit from the advances made in extremity trauma care and prosthetic componentry Coalition forces that sustain severe extremity trauma and limb loss benefit from training missions (to date Iraq, Pakistan, Thailand, Laos, Vietnam, Philippians, Cambodia, Columbia, Sri Lanka, Canada, and England)
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How well utilized is the EACE

While the EACE is in the development stage, The system of
care includes all major rehabilitation facilities within the DoD and the Veterans Health Administration, and includes 7 VA Regional Amputee Care Centers These facilities have carried the vast majority of the treatment demands of the current conflicts where extremity trauma accounts for as much as 82% of all warriors evacuated from theater for battlefield injuries There are numerous research efforts including collaboration between DoD facilities as well as collaboration between DoD and VA to improve the care of our wounded warriors
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What prevents higher utilization of the EACE

Formal approval of the location for the Executive Office Approval of the Concepts of Operation
VA is waiting for approval of CONOPS before fully engaging

Development of a Data Registry to support

tracking of patients across the DoD/VA continuum of care Hiring personnel awaiting for approval of location

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The Armys Home for Health

Saving Lives and Fostering Healthy and Resilient People

~ Partnerships Built on Trust

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