Prosthetist Consults on 'ER'

Randall Alley, BSc, CP, FAAOP

ER viewers who tune into NBC every Thursday night watched as the bullying Chief of Emergency Medicine Dr. Robert "Rocket" Romano had his arm severed by a helicopter blade, ultimately necessitating the use of a prosthetic arm. Following the dramatic amputation, viewers witnessed Dr. Romano's struggle to come to grips with the prospect he may never operate again.

Although Paul McCrane, who played the part of Dr. Romano, is not an actual amputee, through the use of innovative camera effects and computer-generated imaging techniques, he convincingly portrayed one on the show. While advanced technology turned an able-bodied actor into a fictional amputee character, it would take more than computer-generated imaging to understand and accurately portray natural amputee movements, as well as intelligently discuss prosthetic terminology and outcomes among the show's actors.

Alley Gets 'Hollywood Break'

For every storyline of the real-life drama ER, scriptwriters consult real physicians, surgeons, and nurses. Those same medical professionals work onsite with ER directors, producers, and actors when shooting each episode. Dr. Romano's storyline is no exception. In fact, it even demanded an additional level of medical consultation-an onsite O&P expert. For this, NBC turned to Randall Alley, BSc, CP, FAAOP, who has specialized in upper-extremity prosthetics for 11 years and who currently heads clinical research and business development for Hanger Prosthetics & Orthotics Upper Extremity Prosthetics & Orthotics Program. Alley also is the chair of the Upper Limb Prosthetic Society of the American Academy of Orthotists & Prosthetists (AAOP) and an international consultant and lecturer.

Alley was called upon to help with the accuracy of various scenes involving the use of a prosthesis, spoken dialogue, or technical assistance for McCrane and/or those in charge of props. Each episode was checked for technical accuracy and for details as how to imitate walking or manipulating the prosthesis.

So, how did Randy receive his "big Hollywood break?" After an unsuccessful consultation with another prosthetist, ER's prop master extensively searched the O&P field for a recognized and accomplished upper-extremity specialist. The prop master was informed by several individuals that Alley was the best person for the job. Alley received a phone call from the show and was on the set the next day.

Although ER is not filmed in an actual emergency room, the show's producers place such high importance on the accuracy of the show's medical content that, during Alley's consultation, he felt very familiar with the emergency room set, almost as if it were the real thing. "It was amazingly similar to being in a real hospital. The set was very large and extremely accurate. It was easy to forget I was in Warner Brothers' Studio in Burbank, California."

A Positive Experience

Alley recalls the first day he walked in on the set, "There was one scene being taped when I arrived on the set in which Paul McCrane was discussing his disappointment with the cable-driven prosthesis. I was listening to the dialogue and was shocked to find out that the terminology being used was incorrect. I informed them of the error and they re-shot the scene."

In order to avoid the inherent difficulties of shooting scenes approved by those not familiar with upper-extremity prosthetics, Alley suggested the producers seek advice from Alley prior to the completion of the scripts. Realizing that Alley's extensive knowledge of prosthetics would be an excellent resource for writing the scripts, Alley was able to convince the producers to let him participate in the producers' meetings.

Alley worked on three episodes before the producers decided to write Dr. Romano's character off of the show. "It was always going to be a temporary assignment as the producers began to recognize the difficulties of attempting to use a prosthesis on an individual who isn't a wearer. I was informed several months ago about Dr. Romano's eminent demise, but had to keep things quiet before the show aired."

Motion Control's Utah Arm also got a moment of fame as the myoelectric prosthesis used by Dr. Romano.

Alley found his "big Hollywood break" to be a very positive experience. "It was fun, even if for a short time. I hope it brought awareness to the public about the challenges individuals with upper-limb loss face every day."