Falklands war 25TH anniversarY - Boekje Pienter

THE FALKLANDS WAR
Commentary on
Army Amputees from the Falklands - a review
JR Army Med Corps 1984; 130: 114-6
LT Col John Etherington
Consultant in Rehabilitation, DMRC Headley Court
It was both timely and fascinating to read the paper that LtCol
Groom and Maj Gen Coull wrote on the management and
subsequent rehabilitation of amputees from the Falklands War.
Some of us can recall some of the legacy patients from that war
in the military hospitals of the 80’s and 90’s. The paper reminds
us of the constant of modern warfare, but also serves to
highlight the differences in service provision since the Falklands
conflict.
In 1982, service amputees would have been referred to the
local NHS Limb Fitting Centres. Since June 2006, the Armed
Forces have had its own Limb Fitting Centre located at the
Defence Medical Rehabilitation Centre (DMRC) at Headley
Court. The service was developed in response to the inconsistent
provision of limb fitting for the serving personnel. This paper
states that the service provided was exceptionally good with
rapid provision in prosthesis. With notable exceptions, such as
the West Midlands Limb Fitting Centre, over subsequent years
prosthetic provision was inconsistent, often slow and inevitably
limited by local NHS financial pressures. This often led to
frustratingly long periods waiting for limb refitting, with delays
in rehabilitation. After prolonged staff-work at all levels in the
DMS, money was made available to provide a service-wide
Limb Fitting Centre. A private company is now contracted to
provide prosthetic sevices, which are manufactured at DMRC
and fitted to the individual there. This new service provides
rapid prescription and adjustment of the prosthesis whilst at the
same time allowing continued rehabilitation of the patient.
This month will complete one year of prosthetic provision at
Headley Court. We are subsequently auditing our throughput
and early outcomes, which we hope will be a subject of a
publication in this journal shortly.
The current data indicates that there are currently 62
amputees serving in the Armed Forces, many of whom have
been in the Services for some years. There have been 42 cases
treated at DMRC since June 2006 and we have records of 25
aeromedically evacuated cases during the same time. The figures
are comparable to those reported by Groom and Coull, with an
almost identical distribution of amputation levels.
From a rehabilitation perspective the authors make two very
interesting points. Firstly, that the potential occupational
outcome for soldiers with below knee amputations is very good.
Higher amputation levels are associated with longer
rehabilitation times and lower functional outcomes. The longterm
vocational outcomes of these servicemen remains
unknown but with the technical improvement in prosthetic
provision functional capability is likely to be higher than 1982.
Consequently, I believe, we may need to review our concept of
medical grading for these patients, considering both functional
potential and the aspirations of the individual.
Secondly, the authors raise our attention to the psychological
factors, which influence the rehabilitation outcome of
amputees. Interestingly, they state that management of this is
the responsibility of the doctors treating the wounds and of
voluntary and welfare organisations. The necessity of support to
families of injured service personnel is also stressed. Fortunately,
I believe our provision in this area has improved considerably.
There is widespread recognition of the influence of
psychological factors on the outcome of recovery and every
effort is made by the acute services and rehabilitation team to
identify and ameliorate these issues, even from the point of
wounding. All members of the rehabilitation team contribute to
this, but particularly those from the mental health, occupational
therapy and social work teams. I believe that group-therapy, led
by a military remedial instructor within a rehabilitation unit
with a Service ethos, together with similarly injured wounded
service personnel, contributes to their psychological support and
hopefully their long-term outcome.
This paper illustrates that whereas the types of injuries
sustained then and now are very similar, there has been
significant progress in rehabilitation provision in the Defence
Medical Services with the aim of returning the injured back to
the maximum possible psychological and physical health.
JR Army Med Corps 153(S1): 43 43