DOD paradigm shift in care of servicemembers with major limb loss.

Military operations in Iraq and Afgha nistan present a multitude of chal lenges for the U.S. Armed Forces. Wh ether operating in an urban environ ment, such as Baghdad, or the rural mountains of Afghanistan, combat military units need to be flexible to adapt to the constant changes on the battlefield. In support of th ese military operations, th e Military Health Care System (MHCS) needs to be equally flexible. Advances in body armor , expertly trained field medics, forward-area surgical support, and modernized evacuation systems greatly increase co mbat wound survival rates. Despite these advances, to date more than 4,000 servicemembers have died in the line of duty and countless others have been injured. Military professionals continue to serve their country far from their l oved ones in hostile environ ments and treacherous terrain. Many h ave served on multiple deploymen ts and have witnessed horrific human tr agedy. The MHCS remains committed to these heroes and their families, not only to provide the best healthcare that is available today but to continually explore new technology and science to deliver even better care tomorrow. The majority of s evere injuries that occur in the combat theater result from a b last. Blas t injuries may occu r from the primary blast wave or the secondary or tertiary effects caused by flying debris or violent displacement of the individual. Given the relative vulnerability of the servicemember ’s arms and legs, severe limb trauma is frequently encountered. Although modern surgical reconstructive techniques have contri buted to a greater preser vation rate of limbs than possible in prior wars, many injured limbs still require amputation. As of January 2010, more than 950 servicemembers sustained one or more major limb amput ations from injuries sustained in Iraq or Afghanistan. Serv icemembers with tr aumatic limb loss re present a much dif ferent patient demographic than their civilian counterparts. More than 85 percent of the servicemem bers who under go amputation because of combat-related injuries are under the age of 35, whereas in the civilian population more than 81 percent are ove r the age of 44. Additionally , most amputations in the civilian population o ccur as a result of diseases such as diabetes or peripheral va scular disease as opposed to the traumatic injuries due to milita ry c onflict. Further, while traumati c amputations do occur in civilian settings, the types of trauma and associate d injuries are often much different than those experienced by our military servicemembers.