Ohio State opens care, training program to treat military service members

The Ohio State University launched a program late last year to better coordinate care for military personnel with complex combat injuries.

The initiative, housed at the university’s Wexner Medical Center and the Ohio State College of Medicine in Columbus, has been in the works for more than two years, said Dr. Amy Moore, a peripheral nerve surgeon who chairs the plastic and reconstructive surgery department at Wexner Medical Center.

The military medicine program’s vision is twofold: to provide multidisciplinary and specialized care—such as advanced nerve procedures, amputee reconstruction and rehabilitation—to service members and to provide a program to train military surgeons.

That’s become crucial as the military has demonstrated improved survival rates alongside a growing severity of combat wounds.

“We have a higher survival than ever in our military personnel,” but also more military service members suffering from combat injuries like torn limbs and damaged nerves, Moore said. Her research, which received Defense Department funding, focuses on improving nerve regeneration and nerve pain after trauma.

Ohio State’s military medicine program encompasses peripheral nerve surgeons, microsurgeons, neuroplastic surgeons, orthoplastic surgeons, reconstructive surgeons and rehabilitation professionals. Wexner Medical Center accepts Tricare, the military’s health insurance program.

“Identifying (military personnel) as a unique population is a really good idea,” said Jeff Goldsmith, founder and president of consulting firm Health Futures. “They do have unique needs.”

Caring for service members and veterans requires coordination across disciplines, including rehabilitation and counseling, said Dr. Kevin Vigilante, chief medical officer and an executive vice president at consulting firm Booz Allen Hamilton. “It’s a specialized area of medicine,” he said.

One of Ohio State’s first steps was hiring a patient navigator to work with military hospitals such as Walter Reed National Military Medical Center in Bethesda, Maryland, to refer patients. Ohio State is also doing outreach to not-for-profits focused on veterans and Veterans Affairs Department facilities.

The program has also sought philanthropic funds to cover expenses such as housing and travel for patients in need, said Dr. Jason Souza, a Navy physician who Wexner Medical Center recruited from Walter Reed. Souza joined in September as director of the orthoplastic reconstruction program and associate professor in plastic and orthopedic surgery.

Ohio State’s vision for the military medicine program is to align with and support the Military Health System, not to replace it, Souza said.

“There’s a very well-known phenomenon called the Walker Dip,” Souza said. The phenomenon, named for late British military surgeon general Alasdair Walker, is also called the “peacetime effect” and refers to a cycle in which combat-injury care improves during conflicts as military hospitals treat these injuries more frequently. But that expertise declines during peacetime.

To address that, Ohio State’s military medicine program aims to train military surgeons at Wexner Medical Center to enhance their clinical skills stateside.

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That could involve treating trauma and cancer patients in need of reconstructive and other subspecialty care that’s also applicable to military settings. Unlike the Defense Department, the private hospital doesn’t experience war-based fluctuations in the number of patients who need reconstructive care, Souza said.

Setting up partnerships under which military clinicians practice at civilian hospitals has helped to ensure military surgeons and other practitioners are ready to respond to trauma injuries, said Air Force Col. Stacy Shackelford, a surgeon and chief of the Joint Trauma System at the Defense Health Agency’s Combat Support Agency.

The Joint Trauma System is a performance-improvement organization that aims to boost outcomes and survivability for combat trauma patients. Such partnerships also give civilian hospitals early access to trauma-care advances the military discovers, said Shackelford, who is not involved in Ohio State’s program.

When creating training partnerships with the military, setting up agreements and procedures for credentialing, licensing and malpractice insurance is key because those administrative challenges can be the biggest roadblocks, said Shackelford, who referred to the guidance on military-civilian partnerships from the American College of Surgeons.

She encouraged civilian hospitals setting up training programs with the military to incorporate other clinical practitioners in addition to surgeons. “Not just our physicians, but our nurses and all our medics really need access to clinical situations.”