Wounded Warrior care at Camp Pendleton is team effort

By Navy Lt. Marc Calestini, Internal Medicine Department, Naval Hospital, Camp Pendleton, Calif.

Marine Sgt. Jorge Toledo, assigned to Wounded Warrior Battalion West, receives an acupuncture treatment for nerve pain and stress control from Justin Heesakker an acupuncturist at Naval Hospital Camp Pendleton's Holistic Health Program. This program provides a Complementary and Alternative Medicine/Integrative (CAM/I) approach to a patient's rehabilitative care. The stimulation of acupuncture points is known to cause the release of hormones such as endorphins to reduce pain and inflammation; and regulate the autonomic nervous system (ANS) to alleviate sympathetic hyper-arousal and promote parasympathetic restoration. (U.S. Navy photo by Douglas W. Allen, Naval Hospital Camp Pendleton, Public Affairs)

With the Navy Medicine adoption of the Patient-Centered Medical Home Port, primary care is becoming more and more a team effort. One place where this is strikingly apparent is with the Wounded Warrior Program at Naval Hospital Camp Pendleton. As the Wounded Warrior Medical Officer, I function as a primary care doctor. Although my patient load is limited to the 200 or so Wounded Warriors on base, it can be a challenging job. These patients’ conditions can be complex with most having a combination of chronic pain, traumatic brain injury and post-traumatic stress, all of which are traditionally difficult to treat.

Thankfully, I am not alone. Every Wounded Warrior has a nurse case manager that helps them arrange medical appointments and tracks their medical progress. Pharmacists interview every Wounded Warrior upon check-in to Wounded Warrior Battalion-West and assist with medication reconciliation. The specialists in Pain Management, Neurology, Orthopedic Surgery, Physical and Occupational Therapy, Radiology and Mental Health are all very helpful in the care of these complex patients. We even have acupuncture and other various alternative medical therapies on hand to assist the Wounded Warriors. Since the opening of the new Hope and Care Center (which houses massage and recreational therapists) I have seen dramatic improvements in many of my patients. To help ensure fast access to care, Wounded Warriors are given priority for referral appointments and I get timely feedback from my medical colleagues, which helps me stay current while managing their care.

In addition to direct patient care, my schedule consists of weekly care management meetings. I meet with the Case Managers, Recovery Care Coordinators (RCCs) and the staff of the Wounded Warrior Battalion (WWBn) to coordinate patient care. I am very thankful for this multi-disciplinary team approach as their expertise, observations and insights into my patients give me a perspective outside the boundaries of the routine medical appointment. The RCCs and WWBn staff also provide benefits to my patients that go beyond medical support services, preparing them for success either as a civilian or upon return to full duty.

Despite the many dimensions of their care, the Wounded Warriors can always rely on me and the remainder of the “Green Team” (what we in the Internal Medicine clinic call the Wounded Warrior Medical Home Port) for continuity of care. Our team sees them upon checking into the WWBn and we follow them until they check-out. Because a Wounded Warrior’s conditions can be more complex than the average patient, our team model of patient-centered care stands as an excellent example of how we are providing the best possible care for our patients.

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