Integrated musculoskeletal rehabilitation care at a comprehensive combat and complex casualty care program.
OBJECTIVE
The purpose of this study is to describe the musculoskeletal rehabilitation model used to care for combat and severely wounded or ill US military service members at an integrated Comprehensive Combat and Complex Casualty Care center located at Naval Medical Center San Diego.


METHODS
Through a collaborative and iterative process, providers from the various services included at the Comprehensive Combat and Complex Casualty Care program developed a description of the integration of services provided at this location.


RESULTS
After construction of the facility in 2007, the program has provided services for approximately 2 years. Eighteen different health care providers from 10 different specialties provide integrated musculoskeletal services, which include primary care, physical therapy, occupational therapy, vestibular therapy, gait analysis, prosthetics, recreational therapy, and chiropractic care. At the time of this writing (early 2009), the program had provided musculoskeletal rehabilitation care to approximately 500 patients, 58 with amputations, from the operational theater, Veterans Affairs, other military treatment facilities, and local trauma centers.


CONCLUSIONS
The complex nature of combat wounded and polytrauma patients requires an integrated and interdisciplinary team that is innovative, adaptable, and focused on the needs of the patient. This article presents a description of the model and the experiences of our musculoskeletal rehabilitation team; it is our hope that this article will assist other centers and add to the small but emerging literature on this topic.
Goldberg
Capt Kathy F
CK
Naval Medical Center, San Diego, CA, USA.
Green
Bart
B
Moore
Jacqueline
J
Wyatt
Marilynn
M
Boulanger
Lynn
L
Belnap
Brian
B
Harsch
Peter
P
Donaldson
David S
DS
D002140:California; D003191:Comprehensive Health Care / Q000458:organization & administration*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D006298:Health Services Administration; D006801:Humans; D007400:Interprofessional Relations; D008503:Medical Staff; D008511:Medicine / Q000458:organization & administration; D008887:Military Medicine / Q000458:organization & administration*; D009140:Musculoskeletal Diseases / Q000534:rehabilitation*; D009788:Occupational Therapy / Q000458:organization & administration; D026761:Physical Therapy Specialty / Q000458:organization & administration; D010810:Physical and Rehabilitation Medicine / Q000458:organization & administration; D014857:Warfare