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Sudden Impact

Chris Hartlove

Sudden Impact (continued)

The military’s long history in dealing with and closely following soldiers throughout their recovery is an area of great interest for MacKenzie’s team. That close follow-through is often missing in civilian treatment, where patients move quickly from highly structured acute care facilities to the home setting, frequently without getting proper physical and psychosocial rehabilitation.

MacKenzie’s team will examine the effectiveness of rehabilitation in both the civilian and military settings as part of a new cooperative agreement with the Department of Defense (DoD).

Last September, they received an $18.4 million grant from DoD to establish the Major Extremity Trauma Research Consortium (METRC) and address pressing issues in the initial care of patients with serious limb injuries. An additional $43.5 million award has been recommended for funding this fall. It will be used to expand METRC and address other priority topics in acute care and rehabilitation of trauma patients injured at home or in combat.

METRC will conduct research at more than 24 civilian trauma centers, as well as the four military treatment centers caring for the majority of service members injured in the line of duty, says MacKenzie. The data will be coordinated through and analyzed by MacKenzie’s group, which is also helping to design the clinical studies.

“I chose to push forward with my life. I’m a young guy with a lot to live for."—Ryan Major

“The initial studies include randomized control trials looking at promoting fracture healing and preventing major complications like deep infection and compartment syndrome [severe muscle swelling],” she says. “We will also be looking at long-term rehab issues. We’re proposing a trauma collaborative care intervention, a multimodal approach that addresses the needs of trauma patients as they transition back to the home and community. The intervention combines the TSN’s services, including NextSteps, adds training providers to promote TSN use, and makes available a ‘recovery coach’ who advocates for the patient and links them to services after they leave the trauma center.”

MacKenzie’s colleague from the LEAP study, Michael Bosse, chairs the consortium. A retired U.S. Navy captain, Bosse, the director of Orthopedic Clinical Research at Charlotte’s Carolinas Medical Center, notes that the cost of the research is high, but small compared to the economic loss from severe trauma injuries.

 “Look at the disability rates; you take a guy in his 20s who gets a severe leg fracture. You don’t achieve maximum outcome because you don’t know what the gaps are, psychosocially or physiologically. So for the next 40 or 50 years the patient is disabled and on the public’s payroll because we failed to do as much as we could up front,” says the veteran trauma surgeon. “Those are the tremendous opportunities here regarding care of these patients.”

“It’s a very exciting moment for this field,” agrees Renan Castillo, PhD ’08, MS, an HPM assistant professor and MacKenzie’s deputy director on the project. “These studies are going to, hopefully, answer big questions. It’s not unreasonable to speculate that the METRC studies, like the LEAP study, that was designed to answer one question but ended up providing data for a number of other questions, will lay the foundation for additional studies. Ellen has shown she can bring the clinicians together, and has already successfully built networks like METRC. When you think of Ellen, you think of someone who can get it done.”

That’s the kind of mindset a soldier like Ryan Major can appreciate. One day removed from his first kayaking expedition on the Potomac, he’s a man in motion. The knowledge and care of his clinicians and therapists have him in a new pair of short prostheses without knee joints (“stubbies,” he laughs), and if he adjusts well to them, the next step is… a real step, in full-length prosthetic legs.

Mentally, he says he’s already adjusted. when asked if he’s in a good mindset, his youthful voice is strong and unwavering. “Most definitely. I chose to push forward and get on with my life. I’m a young guy with a lot to live for—family, friends and things I dream of doing.”

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