IRAQ WAR CLINICIAN GUIDE

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Iraq War Clinician Guide 56 Traumatized Amputee - - - and receive disability allowances through the Department of Veterans Affairs (VA) system. Questions related to military retirement, monetary compensation and future military benefits are understandably concerning to many of these military patients. Different rules apply depending upon time in grade and upon the component to which the service member is assigned (e.g., active duty, reserve, or National Guard). Some service members appeal medical board recommendations for military discharge and they request to stay on active duty. For some, patriotism and their military identities drive their motivation to remain in service. They don't want to give up their uniform, positions or benefits for their family. Improvements in prosthetic devices have facilitated this process by allowing many more amputees to continue to function effectively in the military service, albeit not in a combat role. WRAMC PCLS clinicians help amputees develop realistic goals for their futures that may or may not include continuation on active duty status. Those military patients who have questions related to the medical board process, disability or other retirement benefits are referred to other appropriate resources. Conclusions Taking care of the amputee patient is a challenging, but rewarding process. The WRAMC PCLS service has effectively incorporated the principles of PMP and TlPPS in successfully supporting and treating service members who have been medically returned from Operation Iraqi Freedom. Amputee patients, similar to other trauma patients, benefit from active engagement by mental health clinicians who assist them in integrating their traumatic experiences and who monitor the development of psychiatric symptoms or disorders. Although the primary preventive effect of these approaches remains unclear the process of post-discharge tracking of patients seems to be an effective secondary and tertiary preventive approach. Such post-discharge follow up identifies those patients who develop more serious symptoms or disorders. They then can be referred for more intensive treatments. Therapeutic considerations unique to the amputee patient include the psychological impact of the trauma on body integrity, apprehension about the impact of the amputation on future functioning and the development of intimate relationships, the effective incorporation and use of the prosthetic device, and concerns about medical discharge, disability and future benefits. The mental health team has a responsibility to support amputees and their families as they address all these issues, as well as any others that might develop. References Brown, L.K. (1 990). Traumatic amputation: Mechanisms of injury, treatment, and rehabilitation. AAOHN lournal, 38, 483-486. Caine, D. (1973). Psychological considerations affecting rehabilitation after amputation. Medical/ournal of Australia, 2, 81 8-821. Fisher, W.G., & Samelson C.F. (1 971). Croup psychotherapy for selected patients with lower extremity amputations. Archives of Physical Medicine, 52, 79. Cerhards, F., Florin, I.,& Knapp, T. (1984). The impact of medical, reeducational, and psychological variables on rehabilitation outcome in amputees. lnternationallournal of Rehabilitation Research, 7, 379-388. Hanna, B. (1996). Sexuality, body image, and self-esteem: The future after trauma. lournal of Trauma Nursing, 3, 13-17. u DEPARTMENT OF VETERANS AFFAIRS - NATIONAL CENTER FOR PTSD
Iraq War Clinician Guide 57 Traumatized Amputee Haslam, E.T., Risinger, D., Metcalfe, R., & Oswald, R.J. (1960). Rehabilitation of lower extremity amputees. The Bulletin of the Tulane University Medical Facility. 20, 23-28 Mendelson, R.L., Burech, I.C., Polack, E.P., & Kappel, D.A. (1986). The psychological impact of traumatic amputations: A team approach: Physician, therapist, and psychologist. Occupational Injuries, 2, 577- 583. Murray, C.D., & Fox, J. (2002). Body image and prosthesis satisfaction in the lower limb amputee. Disability and Rehabilitation, 24, 925-931. Olson, I.K. (2002). Let the healing begin. Contemporary Long Term Care, 25, 23-24. Ronaldson, A. (1999). Coping with body image changes after limb loss. Nursing New Zealand, 5(1 I), 14-16, Wain, H.I. (1 979). Hypnosis on a consultation-liaison psychiatry service. Psychosomatics, 20, 678-689. Wain, H.I., & Jacaard, J.T. (1996). Psychiatric intervention with medical and surgical patients of war. In R.]. Ursano & A.R. Norwood, Emotional aftermath of the Persian Gulf War (pp. 41 5-442). Washington, DC: American Psychiatric Press. Wain, H.I., Crammer, C., Stasinos, 1.. &Miller, C.M. (2002) Meeting the patients where they are: Consultation-liaison response to trauma victims of the Pentagon attack. Military Medicine, 167, 19-2 1. Wain, H.J., Crammer, C., Stasinos, I.,& DeBoer, C. (2004). Psychiatric intervention for medical surgical patients following traumatic injuries. Manuscript submitted for publication. Wain, H.J., Crammer, G., & DeBoer, C. (2004). Therapeutic intervention andprevention ofpsychiatricstress disorders with medical surgical patients following traumatic injuries. Manuscript submitted for publication. DEPARTMENT OF VETERANS AFFAIRS NATIONAL CENTER FOR PTSD
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