More than 160 U.S. military service members have suffered amputation of at least one major limb during Operation Enduring Freedom (Afghanistan) and Operation Iraqi Freedom following the attacks on New York City and the Pentagon on September 11, 2001. The majority of their traumatic injuries have occurred due to blasts, such as from improvised explosive devices, landmines, and rocket-propelled grenades, and due to small weapons fire.
The care of these service members, representing each of the military services, has included immediate life-saving care and rapid medical evacuation in the theater of war for further medical stabilization and treatment. The average time for further medical evacuation from the theater of war to Germany and then to the United States is approximately one week.
The majority of amputee service members receive a major portion of their initial amputee rehabilitation at the Amputee Center at Walter Reed Army Medical Center (WRAMC) in Washington, D.C. WRAMC is a central part of the U.S. Army Amputee Care Program that seeks to help young adult, otherwise healthy, amputee service members return to their previously high level of function to the fullest extent possible.
In addition to each patient and his or her family, the amputee rehabilitation team includes many healthcare providers from different disciplines, such as doctors, nurses, physical and occupational therapists, prosthetists, and a variety of counselors. However, the team members who continue to receive the highest satisfaction rating by patients attending the Amputee Clinic at WRAMC are the volunteer peer amputee visitors (PAVs). When the first traumatic amputees started to arrive from overseas to WRAMC, several fellow amputees with experience visiting new amputees volunteered their time to help provide peer support. From the initiative of these few individuals, a more robust peer amputee visitation program has developed.
Peer amputee visitors seek to support new amputees and their families through their initial and ongoing ups and downs adjusting to limb loss. PAVs also serve as role models and can provide information about amputee rehabilitation, including the unique aspects of being a service connected amputee. With the public's and media's attention on the current overseas military operations, new amputee service members at WRAMC commonly have the opportunity to receive many visitors beyond their immediate family members, such as well-known military, government, and civilian individuals, as well as other well-wishers. However, preserving the opportunity for developing an important relationship that only peer amputee visitors can form with new amputee patients became an integral part of the WRAMC amputee care program.
Peer amputee visitors have been special members of the amputee care team at WRAMC over the last two years. WRAMC has partnered with the Amputee Coalition of America (ACA) to sponsor two annual one-day PAV training programs (August 2003 and July 2004). This joint effort is one of many that have nurtured a positive relationship between the ACA and WRAMC staffs. At this time, approximately 25 ACA-certified peer amputee visitors have been trained, and many of them are active visitors. This group of peer visitors includes several with recent amputations, but most were injured service members from earlier military conflicts dating as far back as the Korean Conflict. In addition, several dedicated non-peer amputee visitors have been trained and include a spouse, a physical therapist, and other friends.
Each week, peer amputee visitors offer support to new amputees at WRAMC on the in-patient wards, in the therapy areas, in the out-patient quarters, and during other activities such as dinners and outings. Amputees new to WRAMC are identified upon their admission and arrangements are made to link them, as best as possible, with one or more peer amputee visitors who have a similar level of amputation. In many instances, long friendships have developed between PAVs, new amputees, and their family members.
To protect the confidentiality and privacy of amputee in-patients at WRAMC, PAVs are asked to follow several rules. When seeking to visit in-patients, visitors are asked to report to the Orthopaedic Ward nurses station where a nurse will check the visitor's name on a list of approved PAVs or non-peer amputee visitors. If the name is on the list, a nurse will then ask the patient whether he or she wants to be visited at that time after providing information about the potential visit. Similarly, in the therapy areas, PAVs are asked to check with staff (therapists, prosthetists, etc.) when they arrive for a potential visit because the amputee patient may be engaged in treatment or otherwise not wish to be visited at that time. Unfortunately, there have been a few distressing incidents when even well-intentioned amputee visitors tried to visit amputee patients without patient or staff knowledge. In addition, some amputee visitors who are also affiliated with prosthetic or orthotic companies have visited with seemingly pure intentions but have engaged in actions that seem to promote the needs of their companies. As written in the ACA peer amputee training guide, “a peer visit is not about you; it is about the person you are visiting.”
In addition to the relationships developed with ACA-certified PAVs, new amputees at WRAMC have benefited from visits from amputees associated with a variety of supportive groups. For example, the VA/DAV National Disabled Winter Sports Clinic, Disabled Sports USA, Paralympic team members, and the Achilles Track Club have engaged the imagination of many new amputees to participate in a variety of recreational events.
Weekly, there are local opportunities for new amputees to learn about or participate in running, golfing, kayaking, and skeet shooting. Not to be forgotten is the fact that, by design, the majority of recent military amputees have been co-located on the same ward at WRAMC where those amputees who are months out from their trauma can help support those who may be only days or weeks out from their injuries. This co-location also facilitates out-patient amputees to return to visit the newer arrivals.
In summary, the peer amputee visitation program has been a very active and vital part of the overall amputee patient care program at WRAMC. The WRAMC amputee care team is very open to including additional peer amputee visitors, particularly those who are ACA-certified. Also, it would be helpful to have additional female amputee peer visitors, including those with upper- and lower-extremity amputations. When amputee patients leave WRAMC and return to their home communities, they also receive information about local amputee support groups listed in the ACA support group database. In addition to WRAMC, other military medical treatment facilities, either in the Army or among the other military services, may wish to begin or strengthen their peer amputee support services. If so, the names of the appropriate people to contact can be provided so that they can begin a dialogue toward the establishment of focused peer amputee visitation programs.
