June 22, 2016
Quality of care across civilian and military trauma systems varies greatly, depending on where someone is injured, and the disparity leads to preventable deaths, according to authors of a new report from the National Academies of Sciences, Engineering, and Medicine.
“Nearly 1000 service members died of potentially survivable injuries in [the wars in] Afghanistan and Iraq, and 20 to 30 times that number of US trauma deaths each year may be preventable,” Donald M. Berwick, MD, MPP, from the Institute for Healthcare Improvement in Cambridge, Massachusetts, and colleagues say in a commentary published online June 17 in JAMA.
Dr Berwick chaired the Committee on Military Trauma Care’s Learning Health System and its Translation to the Civilian Sector, which wrote thereport.
A summary of the report notes that trauma is the leading cause of death for Americans younger than 46 years, and in 2013, trauma was linked to an economic loss of about $670 billion in medical care expenses and lost productivity. The committee estimates that with optimal care, nearly 30,000 of the 147,790 deaths from trauma in 2014 may have been preventable.
At this time, civilian trauma care is delivered in regional systems in which mortality rates vary twofold between the best and worst centers in the nation.
Dr Berwick and coauthors called on the White House to direct the US Department of Health and Human Services and the US Department of Defense to build a national trauma care system aimed at reducing the number of preventable deaths after injury to zero.
“The report concludes that military and civilian trauma systems are inextricably linked, even if leaders sometimes seem unaware of that,” they write. “Military and civilian trauma care and learning will be optimized together, or not at all.”
War Brought Medical Advances
More than a decade of war in Iraq and Afghanistan has brought innovation in trauma care, especially in bleeding control and resuscitation improvements and neurocritical care interventions.
For example, the authors write, widespread use of tourniquets meant 1000 to 2000 lives were saved.
During those wars, the percentage of service members who died from their injuries hit an all-time low of 9.3% compared with 23% in the Vietnam War, the authors write. But lessons learned from these wars are in danger of being lost.
Authors say a coordinated system should collect and share common data across the entire continuum of care, including prehospital trauma care and long-term follow-up.
In addition, they write, “Trauma care practitioners at all levels, including trauma surgeons and other physicians, nurses, technicians, and prehospital care personnel, should have access to data on their performance relative to that of their peers.”
Toward that end, incentives should be put in place to encourage all personnel in military and civilian trauma systems to participate in a structured quality improvement process, they write. In addition, the United States needs a coordinated trauma research program with resources matching the importance of injury.
“The nation should and, with proper leadership, can do better for the soldiers, sailors, airmen, and marines it sends into harm’s way,” the authors conclude. “And every US resident should have the best possible chance for survival and functional recovery after injury. When it comes to trauma care, where people live ought not to determine if they live.”
The report described in this viewpoint was sponsored by the American College of Emergency Physicians, the American College of Surgeons, the National Association of EMS Physicians, the National Association of Emergency Medical Technicians, the Trauma Center Association of America, the US Department of Defense, the US Department of Homeland Security, and the US Department of Transportation. The authors have disclosed no relevant financial relationships.
JAMA. Published online June 17, 2016. Full text
Unifying Military and Civilian Trauma Plans Could Save Lives. Medscape. Jun 22, 2016.