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Staying Power: Seriously Wounded Warriors Return to the Fight

Army Program Reinvents Wounded Care
By Fred W. Baker III
American Forces Press Service

Army Capt. Chris Thoma, commander of Able Troop, Warrior Transition Brigade, at Walter Reed Army Medical Center, talks with platoon sergeant Sgt. 1st Class Frank Boyd about soldier issues. The Army transformed its wounded warrior care into a system that puts the soldiers and family members at the center of care, surrounded by protective layers of leadership, case managers, doctors, support specialists and senior leader oversight. DoD photo by Fred W. Baker III
Army Capt. Chris Thoma, commander of Able Troop, Warrior Transition Brigade, at Walter Reed Army Medical Center, talks with platoon sergeant Sgt. 1st Class Frank Boyd about soldier issues. The Army transformed its wounded warrior care into a system that puts the soldiers and family members at the center of care, surrounded by protective layers of leadership, case managers, doctors, support specialists and senior leader oversight. DoD photo by Fred W. Baker III  
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WASHINGTON, Oct. 2, 2008 — When the first news stories broke in February 2007 detailing a breakdown in soldier and family care at Walter Reed Army Medical Center in Washington, D.C., senior Army leaders scrambled into action.

Headlines screamed of neglect as the nation's highest leaders, from the Pentagon, Congress and the White House demanded an answer as to how this could have happened.

In fact, there was no single answer. And Army officials soon discovered that the problem was systemic and not isolated at Walter Reed.

Five-and-a-half years of combat on two fronts, coupled with historically high combat survival rates, had thrust hundreds of soldiers, battered and broken, and their families, into a bureaucratic health and rehabilitation system that had all but lay dormant for nearly 30 years.

"Once we became engaged in the two wars, when we started to look for those rehabilitative capabilities, they really didn't exist," said Army Brig. Gen. Gary Cheek, the Army's assistant surgeon general for warrior care and transition. "We didn't take good care of the families. We weren't watching out for the soldiers. We also really didn't know what was going on."

Soon, Defense Secretary Robert M. Gates would proclaim that, next to fighting the wars in Afghanistan and Iraq, taking care of wounded warriors was to become the Defense Department's highest priority.

What followed was an all-out Army assault on the broken systems, substandard living conditions, scattered family support programs, and even passive leadership that had contributed to the breakdown in wounded warrior care.

Over the past 20 months, the Army has reinvented its wounded warrior care program, creating a system that puts soldiers and family members at the center of care, surrounded by protective layers of leadership, case managers, doctors, support specialists and senior leader oversight.

Transformation Goes Full Circle

The model for the transformation began at the same place the problems were first discovered. The first newly-designed wounded warrior brigade stood up at Walter Reed only three months after its hand-picked top leaders put boots on the ground there.

"We have made tremendous progress here at Walter Reed, and even more importantly, across the Army in establishing systems that provide much more comprehensive care for our warriors," said Army Col. Terrance McKenrick, the brigade's first commander.

Army Spc. Brent 'Hoss' Hendrix stretches with the help of Staff Sgt. Sara Sutton, a physical therapy technician at Walter Reed Army Medical Center. Soldiers there now collaborate with doctors, case managers, occupational therapists, specialty care providers on a comprehensive transition plan that maps out goals that are needed for the soldier to successfully transition either back into the Army or into civilian life. DoD photo by Fred W. Baker III
Army Spc. Brent "Hoss" Hendrix stretches with the help of Staff Sgt. Sara Sutton, a physical therapy technician at Walter Reed Army Medical Center. Soldiers there now collaborate with doctors, case managers, occupational therapists, specialty care providers on a comprehensive transition plan that maps out goals that are needed for the soldier to successfully transition either back into the Army or into civilian life. DoD photo by Fred W. Baker III  Hi-Res

McKenrick arrived at Walter Reed on March 2, 2007. Three months later, he had a fully operational brigade - a warrior transition unit - with three companies and more than 200 cadre in place to take care of 700 warriors.

Outpatient soldiers who had been scattered in apartments off post with little or no supervision were consolidated in one massive, renovated barracks on the hospital complex where they would be within walking distance of medical care.

Before the brigade was in place, platoon sergeants, who often also were patients, would care for about 50 soldiers each, McKenrick said.

"Most of his day was spent just trying to get accountability," McKenrick said. "He did not have the time to be able to help individual soldiers and families with all of their issues."

Each platoon sergeant there now has three squad leaders who care for about 12 soldiers each. The squad leader is the point man in what the Army has coined the "triad of care." Central to the newly formed layers of support, every soldier has a squad leader, a nurse case manager and a primary care physician.

Before, there were 24 case managers handling an average of 55 soldiers each. Now, there are 39 case managers watching over about 18 soldiers each, McKenrick said.

"It's a much more proactive involvement in helping individual warriors," he said. "They now have the time to do that well and manage those care plans a lot closer than they did in the past."

Delivering Quality Care

There were no primary care physicians in the past, either, McKenrick said. If a wounded soldier needed to see a doctor for something other than his main injury, specialists at the hospitals had to fit those appointments into their already packed schedules. Now each company has an assigned primary care physician who takes on no other patients. Each cares for about 230 soldiers.

The nurse case managers and the physicians are supported by about 20 other staff in a newly renovated warrior clinic housed on the first floor of the main hospital. The area is only for wounded warriors and gives them a central location for all of their primary medical needs. Appointments with specialists throughout the hospital are scheduled by the nurse case managers and squad leaders to ensure the soldiers know when and where to make their appointments.

Also new is the development of a comprehensive transition plan. Launched across the Army's medical command in March, the plan is a collaboration of doctors, case managers, occupational therapists, specialty care providers and the soldiers. The idea is to map out goals that are needed for each wounded soldier to successfully transition either back into the Army or into civilian life.

The plan is in place within a month of the soldier's arrival at the transition unit in outpatient care, said Army Lt. Col. Suzanne Shaw, the senior case manager for the Warrior Transition Brigade at Walter Reed.

"Every warrior is here because they are going to have a major life change. We like to start from the very beginning with developing a plan for the future," Shaw said. "This will really help focus our warriors away from illness and injury and on to productive civilian life or returning to duty."