2009 Issues   /   July 2009 Issue

Trauma Research not Sufficient on the National Agenda

USM By U.S. Medicine
July 26, 2009

WASHINGTON—A national organization comprised of top military and civilian trauma injury experts from around the country is working to draw attention to the need for more trauma injury research. The National Trauma Institute, based in San Antonio, was formalized in 2006. With no single national institute or center devoted exclusively to the funding and development of trauma injury research, the organization has set out to help fill that research and funding gap.

“Our entire premise is to generate public and private money and give it away in a planned and organized way for trauma research projects,” according to NTI Executive Director Sharon Smith. Why is there a need for trauma injury research? There are thousands of deaths on the battlefield and more than 160,000 deaths that occur a year in America from trauma injury, but there is not sufficient trauma research on the national research agenda, according to Smith. “Many organizations feel trauma is a huge problem, but there has never been federal funding for trauma research and it is a huge killer,” said Smith.

Research for Trauma

Many people do not realize the need for trauma injury research, Smith explained. “People don’t think of car wrecks and falling from ladders and senior citizens falling down and breaking their hips,” Smith said. “That is trauma, but people don’t think of all of that. For a breast cancer survivor, there is a huge breast cancer survivor network. But, whether you are military or civilian, if you have been through trauma, there is not a trauma survivors’ group that works from such a grass roots level. So, we have a lot of work to do in terms of raising public awareness to this.”

While trauma is a major problem, there is no “NIH for trauma” or organized national trauma research agenda, according to Smith. “There is a lot of good research going on, but generally, military people and academic people research what they are interested in. On the military side of course, their entire mission is combat casualty care research, but on the civilian side, it is all over the map,” she said.

NTI is seeking to fund, develop, evaluate, and rapidly implement medical technologies that will improve clinical outcomes for trauma patients. Both civilian and military trauma experts determine the organization’s research priorities.

The goal is that the trauma research organization funds will result in new products and outcomes in 1 to 3 years from start to finish. This is a “very short time frame,” compared to projects funded by the NIH, Smith said.

One example of the type of research NTI has been involved in is in blood substitute studies. “It would be a huge thing to come up with a blood substitute that doesn’t need refrigeration and could be carried on the frontlines, and ambulances here at home,” Smith said.

For FY 2010, the organization is asking Congress for $9 million dollars. A large chunk of that funding—$4.5 million—would go towards research addressing noncompressible hemorrhaging, which is a leading priority for military trauma researchers. “Everything has complete translation to the civilian side and vice versa. So, if we are able to help create solutions for noncompressible hemorrhage on the military side, that has equal applicability to the civilian side,” Smith said.

Smith conceded that lawmakers are more apt to listen to the need for trauma research funding as a result of the ongoing military conflicts in Iraq and Afghanistan. War is always a terrible thing, but advances in medical technology do come from war, and so we sing that song a lot when we are talking to our congressional leaders and local officials, and civilians,” she said. “That adds an imperative, because the survival rate is said to be higher than ever before in this war, but that also means that soldiers are coming back with much more serious, long term problems.”

Trauma Research Priorities

NTI was born from a regional consortium that included the U.S. Army Institute of Surgical Research, University of Texas Health Science Center, and three Level 1 trauma centers—University Hospital, Brooke Army Medical Center, and Wilford Hall Medical Center.

After becoming a national organization in 2006, NTI created a national board of 19 civilian and military leaders from the trauma field and from major trauma organizations around the country. “The first thing we did was to broaden ourselves and create a national board. We specifically went after people who are in leadership positions, who are editors of major journals in the trauma field, and who are senior leaders within the whole trauma community,” Smith said.

The board met early this year, and created a list of clinical and translational research priorities for NTI for 2009. In addition to non-compressible hemorrhage, other priority areas include research for blood products and eliminating hospital acquired infections in the ICU.

Not included on the list are issues like TBI, PTSD, or orthopedic extremity injuries. “Anyone would look at the list and think, ‘why they are not doing those things?’ It is because we are not going to throw money at things that are already getting funding of their own,” Smith said. “That leaves a whole array of areas like resuscitation and infection control, and lots of other things that have not gotten anything. That’s what we are focusing on.”


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