Extremity Trauma and Amputee Care High Income Country Capability None End State Minimal Significant Moderate 1 2 3 4 Doctrine No written Standard Operating Procedures (SOP) No Memorandum Of Understanding/ Agreement (MOU / MOA) between stakeholders ( Clinical, Ministries, etc.) Documented SOP’s for individual clinics No MOU/MOA between stakeholders. Clinical scopes of practice not aligned with international standards Documented SOP’s for individual clinics with MOU/ MOA between clinics. No MOU/MOA at Ministry level Developing clinical scopes of practice guidelines aligned with international standards Documented SOP’s for individual clinics with MOU/MOA between clinics MOU/MOA at Ministry level Published clinical scopes of practice aligned with international standards SOP’s written for Multidisciplinary team Legislation and funding for extremity trauma and amputation system of care Organization No identified system of care. Individual specialties operating separately . Regional or local efforts to combine specialties into a system of care. No central funding or oversight Identified centers of excellence. No organizational oversight, no funding earmarked for system of care Identified system of care with complete staffing model, identified funding and organizational oversight. Training Clinical specialties not recognized as professions. No formal training programs for recommended specialties (PT, OT) Training available but programs not accredited by international professional specialty organizations. Recognition of all recommended specialties as professions Developing training programs to international professional standards for 50% of the recommended specialties Training programs that meet international accreditation standards for 75% of the recommended specialties Training programs that meet international accreditation standards for all recommended specialties. Post-professional education opportunities for all specialties Material No dedicated equipment for patient care. 50% of required durable and nondurable medical supplies available ( to include pharmaceuticals) Antiquated or inoperable rehabilitation equipment >50% -<90% of required durable and nondurable medical supplies available ( to include pharmaceuticals) Operational equipment to perform basic exercises for rehabilitation 75% of required durable and nondurable medical supplies available (to include pharmaceuticals) Sufficient functional equipment to allow clinicians to prescribe the most appropriate exercise without being limited by equipment availability All required durable and nondurable medical supplies available with a robust and responsive logistics system in place for resupply. Fully functional equipment available for use. A plan and support in place for lifecycle maintenance and replacement Leadership & Education No dedicated clinical or administrative leaders Single physician appointed as leader of amputee care Physician assigned to lead amputee care team has specialty training has administrative assistance dedicated to amputee care. A physician leader volunteers for the position due to specialty training , experience and desire. Leads for other clinical specialties identified and recognized as leaders. Multidisciplinary team lead a fully qualified physician. Administrative support is dedicated and funded. Chain of Command is published and followed. Personnel No clinical staff with appropriate education and training credentials to treat extremity trauma and amputee patients Trained and licensed physicians performing or directly supervising all aspects of care. Ancillary personnel not trained and not autonomous Trained and licensed physicians supervising a team with 50% of the recommended specialties performing patient care without direct supervision Trained and licensed physician leading a team with 75% of the recommended specialties performing patient care without direct supervision. Ancillary specialties empowered to make independent clinical decisions A multidisciplinary team lead by a physician with all staff members fully qualified and able to operate as part of the team and expected to make independent clinical decisions based on the patient presentation and firm understanding of the team goals Facilities No dedicated clinical space Dedicated clinical space with hand washing available Dedicated clinical space for more than one recommended specialty collocated. Facilities for patient and staff personal hygiene.. Dedicated clinical space with good lighting, environmental controls, dedicated maintenance personnel. Dedicated clinical space allowing the multidisciplinary team to be collocated. Dedicated areas for education, conferences. Dependable lighting and environmental controls. Access to Landline and wireless internet connections. .

Extremity Trauma and Amputee Care Middle Income Country Capability None End State Minimal Significant Moderate 1 2 3 4 Doctrine No written Standard Operating Procedures (SOP) No Memorandum Of Understanding/ Agreement (MOU / MOA) between stakeholders ( Clinical, Ministries, etc.) Documented SOP’s for individual clinics No MOU/MOA between stakeholders. Clinical scopes of practice not aligned with international standards Documented SOP’s for individual clinics with MOU/ MOA between clinics. No MOU/MOA at Ministry level Developing clinical scopes of practice guidelines aligned with international standards Documented SOP’s for individual clinics with MOU/MOA between clinics MOU/MOA at Ministry level Published clinical scopes of practice aligned with international standards SOP’s written for Multidisciplinary team Legislation and funding for extremity trauma and amputation system of care Organization No identified system of care. Individual specialties operating separately . Regional or local efforts to combine specialties into a system of care. No central funding or oversight Identified centers of excellence. No organizational oversight, no funding earmarked for system of care Identified system of care with complete staffing model, identified funding and organizational oversight. Training Clinical specialties not recognized as professions. No formal training programs for recommended specialties (PT, OT) Training available but programs not accredited by international professional specialty organizations. Recognition of all recommended specialties as professions Developing training programs to international professional standards for 50% of the recommended specialties Training programs that meet international accreditation standards for 75% of the recommended specialties Training programs that meet international accreditation standards for all recommended specialties. Continuing Medical education opportunities for all specialties Material No dedicated equipment for patient care. 25% of required durable and nondurable medical supplies available ( to include pharmaceuticals) Antiquated or inoperable rehabilitation equipment 50% of required durable and nondurable medical supplies available ( to include pharmaceuticals) Operational equipment to perform basic exercises for rehabilitation 75% of required durable and nondurable medical supplies available (to include pharmaceuticals) Sufficient functional equipment to allow clinicians to prescribe the most appropriate exercise without being limited by equipment availability All required durable and nondurable medical supplies available with a system in place for resupply. Fully functional equipment available for use. A plan and support in place for lifecycle maintenance and replacement Leadership & Education No dedicated clinical or administrative leaders Single physician appointed as leader of amputee care Physician assigned to lead amputee care team has specialty training has administrative assistance dedicated to amputee care. A physician leader volunteers for the position due to specialty training , experience and desire. Leads for other clinical specialties identified and recognized as leaders. Multidisciplinary team lead by a fully qualified physician. Administrative support is dedicated and funded. Chain of Command is published and followed. Personnel No clinical staff with appropriate education and training credentials to treat extremity trauma and amputee patients Trained and licensed physicians performing or directly supervising all aspects of care. Ancillary personnel not trained and not autonomous Trained and licensed physicians supervising a team with 50% of the recommended specialties performing patient care without direct supervision Trained and licensed physician leading a team with 75% of the recommended specialties performing patient care without direct supervision. Ancillary specialties empowered to make independent clinical decisions A multidisciplinary team lead by a physician with all staff members fully qualified and able to operate as part of the team and expected to make independent clinical decisions based on the patient presentation and firm understanding of the team goals Facilities No dedicated clinical space Dedicated clinical space with hand washing available Dedicated clinical space for more than one recommended specialty collocated. Facilities for patient and staff personal hygiene.. Dedicated clinical space with good lighting, environmental controls, dedicated maintenance personnel. Dedicated clinical space allowing the multidisciplinary team to be collocated. Dedicated areas for education, conferences. Dependable lighting and environmental controls. Access to internet.

Extremity Trauma and Amputee Care Low Income Country Capability None End State Minimal Significant Moderate 1 2 3 4 Doctrine No written Standard Operating Procedures (SOP) No Memorandum Of Understanding/ Agreement (MOU / MOA) between stakeholders ( Clinical, Ministries, etc.) Documented SOP’s for individual clinics No MOU/MOA between stakeholders. Clinical scopes of practice not aligned with international standards Documented SOP’s for individual clinics with MOU/ MOA between clinics. No MOU/MOA at Ministry level Developing clinical scopes of practice guidelines aligned with international standards Documented SOP’s for individual clinics with MOU/MOA between clinics MOU/MOA at Ministry level Published clinical scopes of practice aligned with international standards SOP’s written for Multidisciplinary team Legislation and funding for extremity trauma and amputation system of care Organization No identified system of care. Individual specialties operating separately . Regional or local efforts to combine specialties into a system of care. No central funding or oversight Identified centers of excellence. No organizational oversight, no funding earmarked for system of care Identified system of care with complete staffing model, identified funding and organizational oversight. Training Clinical specialties not recognized as professions. No formal training programs for recommended specialties (PT, OT) Training available but programs not accredited by international professional specialty organizations. Recognition of all recommended specialties as professions Developing training programs to international professional standards for 50% of the recommended specialties Training programs that meet international accreditation standards for 75% of the recommended specialties Training programs that meet international accreditation standards for all recommended specialties. Continuing education available for all specialties Material No dedicated equipment for patient care. 25% of required durable and nondurable medical supplies available ( to include pharmaceuticals) Antiquated or inoperable rehabilitation equipment 50% of required durable and nondurable medical supplies available ( to include pharmaceuticals) Operational equipment to perform basic exercises for rehabilitation 75% of required durable and nondurable medical supplies available (to include pharmaceuticals) Sufficient functional equipment to allow clinicians to prescribe the most appropriate exercise without being limited by equipment availability 90% required durable and nondurable medical supplies available with logistics system in place for resupply. Fully functional equipment available for use. Maintenance available for equipment. Leadership & Education No dedicated clinical or administrative leaders Single physician appointed as leader of amputee care Physician assigned to lead amputee care team has specialty training has administrative assistance dedicated to amputee care. A physician leader volunteers for the position due to specialty training , experience and desire. Leads for other clinical specialties identified and recognized as leaders. Multidisciplinary team lead by a physician with appropriate training and experience. Administrative support is dedicated and funded. Chain of Command is published and followed. Personnel No clinical staff with appropriate education and training credentials to treat extremity trauma and amputee patients Trained and licensed physicians performing or directly supervising all aspects of care. Ancillary personnel not trained and not autonomous Trained and licensed physicians supervising a team with 50% of the recommended specialties performing patient care without direct supervision Trained and licensed physician leading a team with 75% of the recommended specialties performing patient care without direct supervision. Ancillary specialties empowered to make independent clinical decisions A multidisciplinary team lead by a physician with all staff members fully qualified and able to operate as part of the team and expected to make independent clinical decisions based on the patient presentation and firm understanding of the team goals Facilities No dedicated clinical space Dedicated clinical space with hand washing available Dedicated clinical space for more than one recommended specialty collocated. Facilities for patient and staff personal hygiene.. Dedicated clinical space with good lighting, environmental controls, dedicated maintenance personnel. Dedicated clinical space allowing the multidisciplinary team to be collocated. Dedicated areas for education, conferences. Dependable lighting and environmental controls. Access to internet.