Doctors aren’t performing as many combat-related amputations these days.

But with that good news for service members comes one potential downside: Military medical professionals could forget how to treat patients with missing limbs. That happened after the Vietnam War.

“As time goes on some of the skills might atrophy,” said Jason Etchegaray, the lead author of a new report from the RAND Corporation. To prevent that from happening, the report lays out a series of recommendations for the military medical community on keeping their skills sharp.

Through interviews with providers, patients and family members, as well as input from field experts, the researchers identified a series of basic skills that health care professionals need to effectively treat amputees. These range from technical expertise to bedside manner.

“I think it’s very important because we don’t know what the next war is going to be like, and we don’t know when that’s going to occur,” Etchegaray said.

The Military Health System’s Extremity Trauma and Amputation Center of Excellence, or EACE, commissioned the study and plans to use RAND’s recommendations as a starting point for future training of doctors, physical therapists, psychiatrists, prosthetists and others who work with amputees throughout the rehabilitation process.

“We didn’t want to repeat what had occurred following the Vietnam conflict, where the capabilities and the competencies to provide amputee care were slowly lost over time and then we had to relearn those all over again,” said EACE Director John Shero. “We want to make sure that our casualties in the future get at least as good, if not better, (treatment) from that future conflict as our wounded warriors receive and have received over the past series of years.”

In the nearly two decades since 9-11, the Defense Department has treated 1,724 patients with major limb amputations from deployment injuries, Shero said.

The number of service members with combat-related amputations has declined sharply since 2011, when the number of amputations was at a peak of 260, according to the report. There were three in 2018.

Patients are treated primarily at Walter Reed National Military Medical Center in Maryland, Brooke Army Medical Center in San Antonio and the Naval Medical Center San Diego, which have treatment centers specifically designed for military amputees.

These centers take a multidisciplinary approach to patient treatment, requiring regular meetings between health care providers across a variety of services who treat the same patient — not something you typically see in civilian settings, Shero said.

The six basic skills, or “core competencies,” outlined in the report are patient-centered care, evidence-based practice, professional behavior, patient and family education, cultural awareness and teamwork.

Stuart Campbell, chief of global health engagement for EACE, said the center knows its facilities are doing a good job treating amputees, but the RAND report helps define what that looks like on the ground.

EACE will use these findings to roll out a list of key KSAs — knowledge, skills and abilities — required for each medical position in this space, which will eventually be turned into learning objectives and implemented into medical training modules as they are completed.