Late Breaking News
Military Trauma Advances Also Help Civilians, Must Be Maintained
By Sandra Basu
WASHINGTON - Margaret Knudson, MD, was on duty in July when injured passengers began flowing in to San Francisco General Hospital from Asiana Flight 214, which hit a seawall in front of a runway at San Francisco International Airport and skidded to a stop before catching fire. Three passengers died and dozens more were injured.
Thanks to skills learned when she was embedded as a civilian with a medical team in Iraq, Knudson said she was better able to manage the influx of mass casualties.
“The thing I learned the most that was helpful was the ability to triage when all of a sudden you are faced with several very critical patients,” recounted Knudson, National Trauma Institute science committee chair and chief of surgery at the San Francisco General Hospital and Trauma Center.
That’s a real-world example, she told U.S. Medicine, of how lessons learned on the battlefield translate to civilian medicine.
She and other civilian and military trauma experts emphasized recently that investments in trauma research and care shouldn’t diminish along with troop presence as the U.S. mission in Afghanistan winds down.
“I think the message needs to continue to be … how significant this problem is for the civilian community — the hundreds of thousands of people who are injured and the tens of thousands of people killed from trauma that could be saved,” said Army Col. Dallas Hack, MD, who directs the U.S. Army Medical Research and Materiel Command’s Combat Casualty Care Research Program, Fort Detrick, MD.
Hack and a panel of experts on trauma research spoke recently during a teleconference organized by the Army Medical Research and Materiel Command in conjunction with the 2013 Military Health System Research Symposium.
Hack pointed out that, typically, trauma care advancements peak during military conflicts and then decline until the next engagement.
“It is an effort that we are all involved in to try to reduce that cycle depth. I will say there is significant civilian interest in this. I think that 9/11 permanently changed the psyche of this country,” he explained.
Navy Capt. Eric Elster, chairman of the Uniformed Services University School of Medicine’s Norman M. Rich Department of Surgery, Bethesda, MD, said investments in military trauma research remain important, given what he called a “new reality.” As examples, he pointed to mass casualty events such as the Boston marathon bombing and the school shooting in Newtown, CT.
37 Million ED Visits
According to the National Trauma Institute (NTI), each year, trauma in the U.S. accounts for 37 million emergency department visits and 2.6 million hospital admissions, killing three times the number of Americans — nearly 172,000 in 2009, the most recent statistics available — who died during the entire Vietnam War.
Knudson told U.S. Medicine that there is concern in the civilian community about funding levels for trauma research during the interwar years, given that DoD is a primary source for trauma research funds in the civilian sector.
“If they become less interested in studying the trauma world and want to fund other things, then we are all going to suffer,” Knudson said.
Limited funding for such research is a reason why Knudson said continued collaboration between the military and civilian trauma community remains important in the near future.
“The only way we will make progress is if we can work together to go after some of that limited funding,” she said.
Knudson said during the panel discussion that continued collaboration is needed, not only in research, “but also to continue to keep people trained up — using our civilian centers to allow people to rotate through from the military bases so that everyone continues to work together.”
One effort underway is creating a formal program where young military surgeons can train in civilian trauma centers so they will always be deployable and ready, she told U.S. Medicine. That is important, she added, because “a lot of the centers where [surgeons] do their residencies do not have large trauma centers attached to them,” she added.
Air Force Col. Jeffrey Bailey, director of the Joint Trauma System, emphasized the importance of military surgery staying connected with the broader medical community, noting that in the interwar years “it is very likely that very significant advancements will be made in the care of the injured in the civilian community.”
“It is within that larger community that we all practice as trauma and military surgeons,” he said. “So, maintaining those critically important informal and also formal relationships between the military surgery community and organizations like the American College of Surgeons and the American Association for the Surgery of Trauma is going to be the means of anchoring us in that community and keeping us on pace with advancements.”
Air Force Col. Todd Rasmussen, deputy director of the Combat Casualty Care Research Program, said trauma care around the world has been transformed by investments in combat casualty care research.
“The transformation of trauma care has resulted in the lowest case fatality rate for U.S. personnel in the history of war, so it has improved survivability on the battlefield. As a second measure of return on investment, the transformation of trauma care from this experience has translated to the civilian sector,” he said.