The “ Why ”

…the “ Why Not ”

2

How Did We Get Here?

3

Reduced Case Fatality Rate

Synergy of a learning

system in trauma: • trauma system

• trauma research

• trauma ed & training

Didn’t start war with this capability: it developed as matter of urgency & organic

need for continuous, real-time, evidence supported, performance improved care

“Medically Ready Force…Ready Medical Force”

Battalion Aid Station

“Level 1”

In Theater

Hospital

“Level 3”

Definitive Care

“Level 4”

Historical Route From Injury to Definitive Care

CASUALTY EVAC - Evac Policy -

1 Day

TACTICAL

EVAC - Evac Policy -

7 Days

STRATEGIC EVAC - Evac Policy -

15 Days

Field Hospital

“Level 2”

Continuous En-route Care

“Medically Ready Force…Ready Medical Force” 4

Tactical Combat

Casualty Care

Theater

Hospital

Care

Definitive Care

“Level 4”

Today’s Route From Injury to Definitive Care

CASUALTY EVAC - Evac Policy -

1 Day

TACTICAL

EVAC - Evac Policy -

7 Days

STRATEGIC EVAC - Evac Policy -

15 Days

Damage

Control

Resuscitation/

Surgery

Continuous En-route Care

< 1 Hour

“Medically Ready Force…Ready Medical Force” 5

Tactical Combat

Casualty Care

Theater

Hospital

Care

Definitive Care

“Level 4”

Today’s Route From Injury to Definitive Care

CASUALTY EVAC - Evac Policy -

1 Day

TACTICAL

EVAC - Evac Policy -

7 Days

STRATEGIC EVAC - Evac Policy -

15 Days

Damage

Control

Resuscitation/

Surgery

Continuous En-route Care

< 1 Hour

< 24 Hours

“Medically Ready Force…Ready Medical Force” 6

Tactical Combat

Casualty Care

Theater

Hospital

Care

Definitive Care

“Level 4”

Today’s Route From Injury to Definitive Care

CASUALTY EVAC - Evac Policy -

1 Day

TACTICAL

EVAC - Evac Policy -

7 Days

STRATEGIC EVAC - Evac Policy -

15 Days

Damage

Control

Resuscitation/

Surgery

Continuous En-route Care

< 1 Hour

< 24 Hours

2-3 Days

“Medically Ready Force…Ready Medical Force” 7

National Security - Empower the Force

Homeland Security - Lessons for Public

8 “Medically Ready Force…Ready Medical Force”

Military Trauma’s Continuously Learning Health System: 1. Joint Trauma System (JTS): registry-based, real-time performance improvement (CPG)

2. Requirements-driven, medical research & development (knowledge & materiel solutions)

3. Military-specific medical education and training (implement & apply solutions)

45 minute access to level I trauma care

modified from JAMA 2005;293:2626

DoD trauma training/currency platforms in U.S.

centers – disburse knowledge & experience

9 “Medically Ready Force…Ready Medical Force”

Mil to Civ & Civ to Mil

Transfer of Lessons Learned: Injury is leading cause of M&M & lost productive life years

Emergency tourniquets,

war lessons saved lives

in Boston Janice Lloyd,

USA TODAY, April 18, 2013

10

As the Nation looks to bind its wounds from war and now IEDs on US soil, it would be wise to pay heed to lessons learned. Especially in fiscally austere times, emphasis must remain on the military imperative of combat casualty care research. Focus on this clarion

mission will avoid drift and assure that any proposed peace dividends are measured not just in monetary

terms, but in saved and improved lives of those injured on the battlefield and on the streets of this country.

JAMA Surgery, published online January 1, 2014

JAMA 2013;310(5):475

…the “ Why Not”