Gp Capt D W Jones

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Defence Medical Rehabilitation Program

• Gp Capt D W Jones
• Director Defence Rehabilitation

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THE DEFENCE MEDICAL REHABILITATION PROGRAM
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Background
With the closure of the majority of the military
hospitals in the mid 90s regional vocational
rehabilitation ceased to exist with increasing
morbidity which compromised force generation.

• This observation lead to the creation of the
  AFOPS Injury Working Group (IWG).
• IWG was created June 2000 under sponsorship
  DCDS(Pers).
• They reported in March 01.

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IWG Findings

• High Incidence of musculo-skeletal injury
• Amounted to 40 of first attendances at primary
  care
• Equal to 67 Working Days Lost (WDL)
• Army studies showed
• 44.2 of GP attendance's
• 70 WDL
• Training Exercise injury 45 all medical
  discharge

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IWG Findings

• 16,000 service personnel down-graded
• Totalling 8 of the Armed Forces
• As well as a Manning shortfall - Dec 2000 of
  8,725

Stress Fracture
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Quick Wins

• Sharper focus on injuries and proactive stance
• Establish Training Injuries Working Groups on
  Units.
• Education for awareness and prevention.
• Trg agencies to establish best practice
• Review Recruit Standards in Selection and
  Training
• Create a tri-Service rehabilitation authority.

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Defence Medical Rehabilitation Programme
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Principles

• Active Case Management
• Early Assessment
• Local Assessment
• Multidisciplinary Assessment (MIAC).
• Rapid access to Rehabilitation
• Rapid Access to Secondary Care
• Clinical Lead by DMRC

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AFOPS Injury Steering Group Rehabilitation
Concept of Operation.

• A tiered structure of Rehabilitation provision.
• Primary Care Rehabilitation Facility (PCRF)
• Regional Rehabilitation Unit (RRU)
• DMRC Headley Court.

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A Graduated Approach
Injury
Unit Medical Officer
Physiotherapist RI
Primary Care Rehab Facility
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Primary Care Rehabilitation Facility
- Minor musculoskeletal injuries. Expected
return to
fitness in one
month. - Access within two days - Located /
integrated within Med Centre. - Total number -
130
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A Graduated Approach
Injury
Unit Medical Officer
Physio RI
Primary Care Rehab Facility
Regional Rehabilitation Unit
OC Rehab Medical Officer 3 Physiotherapist 3
RIs Admin Officer Visiting Consultants
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Regional Rehabilitation Units

• Multidisciplinary Assessment
• More significant musculoskeletal injuries .
  Diagnostic uncertainty
• Assessment within 10 days in multidisciplinary
  assessment clinic.
• Rapid access to CT and MRI -10 days
• Rapid access to Surgery- Fast Track Program.
• Rehabilitation On-site
• Rapid access to on site residential
  Rehabilitation-30 patients.
• Support to a number of locally identified
  PCRFs..

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DMRP The Role of the RI
Established and Proposed RRU Locations
WHERE ?
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DMRP OUTCOMES

• Accumulated Total for 3 years (1
  Apr 04 - 1 Oct 07)
• Patients Assessed 21368
• Physio/Rehab only 17712
• Referral to Fast Track 2100Ortho
  Surgery
• Referral to routine 1207
  Ortho Surgery
• Number of these discharged from rehab
  11250

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A Graduated Approach
Injury
Unit Medical
Physio RI
Primary Care Rehab Facility
Medical Officer OC Rehab 3 Physio 3 RIs Admin
Officer Visiting Consultants
Regional Rehabilitation Unit
DMRC - Headley Court
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Defence Medical Rehabilitation Centre Headley
Court
Headley Court originally leased at a peppercorn
rent by MOD (originally the Air Ministry) for the
sole purpose of rehabilitating injured or sick
Service personnel.
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DMRC Headley Court
Vocational Rehabilitation Service Moderate to
severe Musculoskeletal , neurological and
amputee rehabilitation (including prosthetics).
Rheumatology Service. Sport and Exercise
Medicine Service Training MOs Junior
Doctors. Entry Officers Cse Dip STIC. Physios
CPD. RI JSSRI. Research Training
Exercise Medicine Advisory Group. Centre for
Injury Research Clinical Assessment. Defence
Patient Tracking Cell. Support to clinical teams
- RCDM, RRU.
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Vocational Rehabilitation

• Medical Rehabilitation
• Education
• Physical Training
• Team-working
• Military Ethos
• Compliance
• Competitiveness
• Return to a normal life

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DMRC Headley Court - Background

• Military Rehabilitation Centre
• Establishment 264 (currently 282) - ratio of
  military to civilian 11
• 170 patient beds of which 66 are ward based

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How DMRC Works Ward Based -Individual
Rehabilitation
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Dedicated In-Patient Beds

• Neurological - 20 Beds
• Polytrauma amputees - 28 Beds
• Rheumatology - 4 Beds

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Amputee Population In The Armed Forces

• Currently 65 serving amputees.
• 40 aero-med April 06- Sep 07
• 49 have been treated at DMRC since June 06
• Source DMRC Amputee Dept.

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Expectations
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Rehabilitation
Camp Dogwood Dec 04
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Group Rehabilitation
PHASE 3
LATES GENERALS
INTERMEDIATE LOWER LIMBS
INTERMEDIATE SPINES
PHASE 2
EARLY LEGS
EARLY KNEES
EARLY SPINES
UPPER LIMBS
PHASE 1
MEDICALS
ASpire
SAA
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Patient Activity
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• During the first 12 months of the war, no
  provision of any sort was made for cases crippled
  and deformed.
• many men were discharged from the Army in very
  large numbers unfit for either military or
  civilian life.
• .to become foci of seething discontent and at
  that time a menace to successful recruiting
  

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QUESTIONS ?