Study Promotes Battlefields’ Lessons to Advance National Trauma Care

Reprinted with permission from Kaiser Health News, a national health policy news service that is part of the nonpartisan Henry J. Kaiser Family Foundation.

Tens of thousands of American lives could be saved each year with a concerted national effort to emulate what top military and civilian trauma centers are doing, a prestigious panel of top medical experts reported Friday.

“It is time for a national goal owned by the nation’s leaders: zero preventable deaths after injury,” said a committee from the National Academies of Sciences, Engineering and Medicine in an ambitious report released six days after the nation’s worst mass shooting took place in Orlando, Florida, ending 49 lives and injuring 53.

Citing the U.S. Army’s 75th Ranger Regiment’s performance in Afghanistan and Iraq, the report praised the special operations force for its successes in treating combat casualties under difficult conditions while virtually eliminating preventable deaths.

Over that 2001-2011 period, “in the civilian sector, as many as 200,000 American lives — the population of the size of the city of San Bernardino, California — could have been saved if all trauma centers in the United States had achieved outcomes similar to those at the highest-performing centers,” the report said.

San Bernardino was the site of a mass shooting last December that killed 14 people.

The National Academies committee called for a national trauma care system to promote learning across the health care spectrum — from an injury scene to hospitalization, rehabilitation and afterward.

“We do not have a cogent or well-designed research strategy on trauma care,” said Donald Berwick, the committee’s chair, in a public briefing on the report Friday.

The committee also urged more research funding. Trauma injuries — which include severe injuries from events such as car accidents, and falls as well as gun violence — are the leading cause of death for civilian Americans younger than 46, the committee said, but injury research drew less than 1 percent of the National Institutes of Health’s biomedical research budget in 2015.

As important, the report — more than 400 pages long — stressed that the U.S. must do more to encourage coordination, collaboration and standardization in trauma care across and within both the military and civilian sectors. Other groups have made similar recommendations, but the committee pointed out there is no central authority for trauma care — in either sector or overall — to promote those goals.

“We want to level the playing field across the country,” said John Holcomb, professor and vice chair of surgery at University of Texas Health Science Center and a member of the committee, in the briefing. “Where you’re injured shouldn’t determine if you live or die.”

Declaring that only the White House has the leverage to achieve the collaboration needed, the committee recommended that the nation’s chief executive set a national aim of zero preventable deaths and lead the integration of civilian and military trauma care.

The committee also offered other direction, suggesting for example that the secretary of Health and Human Services designate a “locus of responsibility” within the department to marshal a sustained effort to achieve these goals at all levels of government, in academia and in the private sector.

One step HHS could take each year, the National Academies report said, is to promote the widespread use of one proven treatment to improve trauma care, such as commercially-made tourniquets instead improvised ones to stop severe bleeding faster.

At the Boston Marathon bombing in 2013 and again in Orlando last week, bystanders aided some badly-wounded victims by applying tourniquets made from clothing such as T-shirts and belts. That is a testament to how the civilian-sector can apply a life-saving lesson from the military, the committee observed.

But according to the report, the military has found improvised tourniquets are not always effective and now favors tourniquets expressly made to stop bleeding. In the civilian sector, the tourniquet lesson has been “lost in translation,” the committee said.