In the tumultuous days after the Sept. 11, 2001, terrorist attacks, Army Surgeon General James Peake came to Col. Chuck Scoville, his chief physical therapy consultant, with urgent questions.
If U.S. troops went into Afghanistan, what should the Army expect in terms of limb-loss casualties? Was the military prepared to care for them? If not, what would it take to be ready?
Based on the Soviet Union’s bloody experience in Afghanistan, it did not take Scoville long to realize that U.S. troops could expect significant losses of limbs from rocket-propelled grenades, mines and other explosives. Moreover, a quarter-century after the United States left Vietnam, the nation’s peacetime military medical care was set up to treat older amputees who had lost limbs to disease, not trauma.
“We were not ready,” Scoville recalled concluding.
It would fall on Scoville and his colleagues to change that.
More than a decade later, as the wars in Iraq and Afghanistan wind down, Scoville serves as chief of the Amputee Patient Care Service at the Walter Reed National Military Medical Center in Bethesda.
As of this month, more than 1,500 U.S. service members suffering major losses of limbs have come through the amputee clinic, both at the Bethesda location and its former home at the old Walter Reed Army Medical Center in Washington. That facility closed last summer and was consolidated with the former Bethesda naval hospital to form a joint services medical center.
Scoville, 60, has been nominated for a prestigious federal worker award for his development of a sports-based rehabilitation program that has changed the blueprint for amputee medical care and is credited with helping hundreds of combat amputees lead active lives. In some cases, amputees have even returned to duty. In the process, Scoville has collaborated with the developers of prosthetics to create a new generation of advanced artificial limbs.
“Chuck’s had a very significant impact on military medicine, and civilian as well,” said Paul Pasquina, chief of orthopedics and rehabilitation at Walter Reed.
Scoville, a nominee for the National Security and International Affairs Medal, is one of 33 finalists in nine categories for the 2012 Samuel J. Heyman Service to America Medals, which are awarded to outstanding civil servants by the nonprofit group Partnership for Public Service. The medals will be awarded in September.
A native of Ohio and physical education major at Ohio University, Scoville began his Army career as a Pershing missile crewman at Fort Sill, Okla., but took advantage of an Army program to earn a master’s degree and a doctorate in sports medicine, his true passion.
He served as an Army physical therapist in Berlin, at the Pentagon and in Hawaii. Assigned to the U.S. Military Academy at West Point in the 1990s, Scoville proposed and established a first-of-its-kind sports-based physical therapy program.
After his assignment in the Army surgeon general’s office, Scoville retired from the service in 2003, intending to go into sports medicine. But the Army asked him to take a civilian job heading the amputee care program at Walter Reed, just as the number of casualties rose with the U.S. invasion of Iraq.
The regimen Scoville developed, building on his experience at West Point, mixed traditional medical care and counseling with sports medicine. Patients participate in intensive workouts and training with state-of-the-art equipment and rehabilitation specialists. Combined with the new generation of prosthetics, this regimen encourages them to take on physical challenges beyond what they could do before their injuries.
“Our guys are professional athletes,” Scoville said. “The only difference is they’re not paid as much, they don’t have an offseason, and they don’t know when the next game is.”
The notion of treating combat amputees as athletes rather than patients has profoundly affected their treatment.
“Our goal has not been just to get out of bed and walk, but to get out of bed and thrive, and not to be limited in expectations,” Pasquina said.
Initially, it was rare for amputees to return to active duty. But during a visit to Walter Reed by President George W. Bush in 2004, an Army staff sergeant who had lost his right leg to a land mine in Afghanistan told the president he wanted to go back to active duty. Bush promised to do what he could to help.
Scoville seized the opportunity presented by Bush’s words. “We took that as an executive order to push them back to active duty,” he said.
More than 300 amputees from Walter Reed have since returned to active duty, including 53 who have gone back to serve in Iraq or Afghanistan. Many others have competed in triathlons, gymnastics, skiing and other sports.
Scoville plays down his role in their success. “A lot of my job is to make sure everyone has what they need, and then stay out of the way,” he said.
Getting the patients what they need has included developing an advanced prosthetic knee suitable for military use. “Chuck saw that the state of the art was not enough,” said Hans Dietl, managing director of Otto Bock, a prosthetic manufacturer that collaborated with the Army to develop a new knee.
Scoville wanted a knee that could run, walk backward, avoid obstacles and climb stairs. It also needed to have a long battery life, be watertight and be resistant to salt water — a knee that could move seamlessly from swimming in the ocean to hiking in the desert.
The engineers “were pushed well out of their comfort zone by these extreme demands,” Dietl recalled. But with constant prodding and feedback from Scoville, the company developed a sophisticated, microprocessor-controlled knee with more capabilities.
They also developed it more quickly than the engineers had thought possible.
“From the very beginning, he pushed us to the limit,” Dietl said.
Scoville waved off the notion that he is driving the development of prosthetics. “It’s coming out of these guys,” said Scoville, gesturing to a dozen or more combat amputees working out in the center’s gym.
Among those working out was Army Cpl. Cody Stanton, a 20-year-old from Raleigh, N.C., who lost both legs while on foot patrol in a village near Kandahar on Feb. 26. Stanton was surprised to find himself being fitted for prosthetic legs soon after his arrival at Walter Reed. “I thought it would be years before I’d be walking,” he said.
Scoville likes to make sure new arrivals can see what others in the same situation have been able to accomplish.
“They got there, so I know one day I’ll be there,” said Petty Officer 1st Class Todd Hammond, 40, a Navy explosive ordnance disposal team member who lost his right leg below the knee to an explosive device in Afghanistan. “It gives you a good outlook.”
In his office, Scoville clicked on a Web site to check the progress of a former patient. “One of my guys is just back from Afghanistan, and now he’s climbing Denali,” he said.
Marine Capt. David Borden, who lost a leg above the knee to a suicide bomb in Iraq in 2008, returned to combat in Afghanistan in 2011. He had joined with five other wounded warriors, two of them double-leg amputees, to attempt to climb Denali (Mount McKinley) in Alaska. The group climbed to more than 15,000 feet before being forced to suspend the climb June 29 because of severe weather.
Scoville would never have discouraged the attempt.
“If you tell them they’re never going to climb Denali, they won’t,” he said.