Rehabilitation Lessons from a Decade of Conflict

Abstract: Blast causes severe and complex injury patterns and significant rehabilitation challenges. By 2011/12, the peak of the Afghanistan conflict, complex trauma admissions into the Defence Medical Rehabilitation Centre Headley Court were equivalent to the total admissions into specialist inpatient NHS rehabilitation for the whole of England. These high casualty numbers enabled the rehabilitation specialists to evolve practice and challenge expectations. The service was built upon existing principles, namely early assessment, exercise-based rehabilitation, cross-disciplinary working, active case management, and rapid access to specialist opinions and investigations. Rehabilitation commenced at the earliest possible point in the intensive care unit in the deployed setting. This then progressed through to the inpatient trauma ward to the delivery of outpatient rehabilitation even while the patients were still in hospital. Finally, the integration of medical rehabilitation and transitional support agencies is critical in the support of the casualty in the final stages of their recovery.