Look to the military to fix U.S. trauma care

Op-ed: If we can create a trauma care system that flourishes in war, we can certainly do it on U.S. soil.

Each year, nearly 150,000 Americans die after being injured by accident or violence. These injuries cause nearly half of all the deaths among people under the age of 46 and cost the nation nearly $700 billion a year. What's even more astounding is that a significant number of the people who die after being injured — as many as 30,000 a year, or 80 every day — could have survived.

A key reason for many of these unnecessary deaths is that state-of-the-art trauma care was not available. Too often, a patient's survival comes down to the luck of location. Some states and cities have hospitals that are staffed and equipped to save the lives of badly injured patients. Other places are not so fortunate. The result: Lives are cut short. As a nation, we can do much better.

The good news: There is a solution. Earlier this year, the National Academies of Sciences, Engineering and Medicine published a report (I am among the authors) on how to improve trauma care in this country. It argues that we should look to our military for guidance. The Department of Defense has already forged a highly successful model for trauma care, one that we can replicate at home.

Since 2001, the U.S. military has fought major wars in Afghanistan and Iraq, and it is currently engaged in smaller conflicts around the world. During this time, nearly 7,000 American service members have died in combat and more than 1 million have been injured. These men and women deserve the best possible trauma care, and our military takes their treatment very seriously. Over the past 15 years, the Department of Defense has steadily improved its approach to treating those who are injured. In fact, the survival rate among service members injured in Iraq and Afghanistan rose to nearly 98 percent.

Some units did especially well at treating combat injuries. The elite 75th Ranger Regiment emphasized the importance of battlefield medical skills for its soldiers. All members of the 75th are required to receive training in casualty care. Their commanders give this training the same priority as marksmanship and other essential military skills. As a result, during the Iraq and Afghanistan conflicts, the 75th Regiment experienced 70 percent less combat-related death (soldiers who died from battlefield wounds) compared with the rest of the U.S. military. This is remarkable, especially because rangers often take on the most difficult and dangerous missions.

Another key to the military's improvement is the development of a "learning health system" for treating war injuries — a system in which people continually analyze data, correct errors, educate providers and upgrade approaches. Systematic data collection identified innovative strategies to improve military trauma care, including the recognition that treatment must begin long before a patient arrives at the hospital. Administrators and doctors use this information to systematize treatment, so that every soldier receives elite care as a matter of course.

If we can create a trauma care system that flourishes in the chaotic, high-pressure environment of war, we can certainly do it here in the United States. The National Academies report lays out a clear plan to integrate the military's approach to trauma care into civilian hospitals and trauma centers. The strategies adopted successfully by the military — continuous improvement, earlier care and systematic treatment — can be used by our civilian trauma facilities to save lives.

The report also notes that there is a symbiotic relationship between military and civilian trauma care. To work best, the two systems must work together much more closely. Over the past century, researchers and clinicians have seen that the military tends to forget lessons learned during previous wars about optimal medical care. Closer cooperation between civilian and military trauma care systems would help break this cycle. We could, for instance, develop a system in which military doctors and nurses are assigned to civilian hospitals, both to transfer their hard-earned knowledge and to keep their skills sharp and up to date. At the same time, civilian patients and doctors would benefit from the expertise of military medical personnel.

The first step is for civilian federal government leaders to acknowledge the scope of the problem and decide to address it. The White House should set a national goal of eradicating preventable deaths after injury. This commitment would mobilize key federal agencies, including the Department of Health and Human Services and the Department of Defense, to begin working in earnest on creating an integrated national trauma care system.

Right now, Congress has crafted two important bills on this issue. One of them, sponsored by Rep. Tammy Duckworth, an Illinois Democrat and combat veteran, would take several of the steps mentioned above to reshape trauma care delivery nationally. The other, authored by Rep. Richard Hudson, a North Carolina Republican, would fund up to 20 military trauma teams and embed them within civilian trauma centers around the country.

This is not contentious. Congress and the next administration should make this issue and these bills a priority. Even in our highly polarized political environment, trauma care is a bipartisan issue. After all, serious injury spans the political spectrum. Improving trauma care will require hard work and leadership, but it can be done. We owe it to our service members, we owe it to the public, we owe it to our nation. Tens of thousands of lives a year depend on it.

Dr. David Marcozzi (dmarcozzi@em.umaryland.edu) is an associate professor at the University of Maryland School of Medicine and formerly served as director of the National Healthcare Preparedness Program in the Department of Health and Human Services. A lieutenant colonel in the U.S. Army Reserves, he has been deployed as a surgeon three times since 2000, to Iraq and Afghanistan, and is now assigned to the Army Special Operations Command.

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