LANDSTUHL, Germany — As chief of rehabilitation medicine at the Veterans Affairs hospital in Tampa, Fla., Dr. Steven Scott spends anywhere from a few months to a few years with patients recovering from battlefield trauma.

Troops arrive at the hospital with limbs destroyed in roadside bomb blasts, gunshot wounds, traumatic brain injuries, burns, infections, paralysis and often more than one of the above.

“How do you rehabilitate someone with all those impairments?” Scott said. “That is the story of polytrauma. The model I always use is if you can move a muscle fiber, we can rehabilitate you.”

Scott helps the servicemembers — many whose injuries would once have confined them to nursing homes — learn to drive without fingers, communicate with the movement of their eyes and, in one case, steer a sailboat rudder with a device that responds to puffs of breath.

But Scott had never seen what his patients experience when they are evacuated from the battlefield until a frigid morning in Landstuhl last week. Several gurneys holding soldiers fresh from Afghanistan were removed from a pale blue school bus and wheeled through the front doors of Landstuhl Regional Medical Center.

“I’ve been working six years and I never realized that,” Scott said of the 15-minute bus ride from Ramstein Air Base to Landstuhl.

The lonely bus trip provided new insight for Scott about what patients experience before they make it to his stateside polytrauma ward.

Scott was among several doctors and nurses visiting Landstuhl last week from four VA hospitals in the U.S. In Landstuhl, they met with staff to find ways to improve communication. They also saw, for the first time, the treatment their patients receive at the Army’s way station for troops injured in war.

It’s a complex affair to get wounded troops from the battlefield to the stateside hospitals.

“You’re talking about injuries that are more severe than we’ve ever had before,” Scott said. “They are kept alive by advanced trauma and medicine, and they are being transferred 8,000 to 12,000 miles for rehabilitation.”

Thousands of documents accrue with every patient moved and treated.

“By the time they reach us in Tampa, they may have been seen by up to 20 doctors and 300 medical professionals,” he said.

The enormous document trail requires records to be quickly updated and accessible across geographic boundaries, so records and images are sent electronically from hospital to hospital. Nurses are devising standardized forms and a tool to send encrypted patient data, said Brenda Stidham, a nurse at the VA hospital in Washington who coordinates trauma care with Walter Reed Army Medical Center.

Far-flung medical staffs — including those downrange, at Army hospitals and at the VA hospitals — also link up weekly via video to talk about patients. For the Landstuhl doctors, who often see their patients for less than a week, it’s an opportunity to monitor patients’ progress after they are gone — once they have moved to Steven Scott’s care in Tampa, for example, or to the polytrauma unit at the VA hospital in Palo Alto, Calif., where Dr. Ted Scott, who has no relation to Steven Scott, works.

Scott was another physician on last week’s tour of Landstuhl. In the intensive care unit, he met a soldier who would soon convalesce at his polytrauma ward. He chatted with Landstuhl’s trauma surgeon, Maj. Brad Putty, about the soldier’s injuries, which were many.

“I’m sure we’ll be sharing many more patients,” Scott said, shaking Putty’s hand.

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