From Stratosphere to Boots on the Ground: The Case Reports Military Trauma Care s Learning Health System and its Translation to the Civilian Sector U.S. Army Institute of Surgical Research LTC Andrew P. Cap, MD, PhD Medical Corps, US Army Chief, Coagulation & Blood Research
The opinions or assertions contained herein are the private views of the author and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense. But I am the COR
A moment of indulgence Focus on Trauma Care = Focus on Surgical Care TCCC = Focus on Medics and the ER MY DEPLOYMENT to a CSH : 2 general surgeons, 1 orthopedic surgeon Lots of other docs, nurses, techs, etc. MY PRE-DEPLOYMENT TRAINING? ZERO! This is a problem. PLEASE don t forget about the rest of the medical forces!
CASE REPORTS Stratosphere Ground Need to ground discussion of learning systems in reality Pictures tell a thousand words We have given you ACTUAL CASES with skeletal discussion & references How can we help you use these to anchor your discussions and report?
Statement of Task Identify & describe key components of a learning health system Characterize components of the Military Trauma System and Trauma Research Investment that enable improvements to care Unique contributions of Defense Health Program research investment vs. other private or Federal efforts Benefits, limitations, relative effectiveness of gap-driven research Characterize how military & civilian education/training systems prepare leaders for the Military Trauma Learning System Define how the Military trauma learning system and research investment should be sustained and expanded in order prepare for future conflicts and translate benefits to civilian sector
4 Case Studies Combat injuries that highlight challenges and opportunities in establishing & sustaining a learning trauma system Use background materials & cases to focus discussion Case studies to be prepared by ISR & JTS staff Structure: brief description of case discussion of how DoD learned bibliography Will serve to anchor meetings that focus on process & structure July: The Military Trauma Care System September: Building & Maintaining the System The Committee may request more info/speakers The case study documents will be appendices to your report (as background documents) The Committee may reference these and use them to illustrate points made in the final report
Case #1: Dismounted Complex Blast Injury Signature wounding pattern of IED detonation Extremity amputation Facial injuries Compromised airway Pelvic & genital injuries Hemorrhagic shock due to non-compressible hemorrhage Junctional & torso hemorrhage Junctional tourniquets REBOA Massive transfusion protocols Genital reconstruction Protective undergarments
Case #2: Exsanguinating leg injury Body armor protects torso; extremities vulnerable Soft tissue injury Open fracture Vascular injury with massive hemorrhage & shock Life-saving role of tourniquets Ischemic time vs. functional outcomes Amputation vs. limb salvage Prosthesis vs. rehabilitation of salvaged limb
Case #3: Severe TBI Major cause of KIA Often associated with polytrauma & hemorrhage Early blood product-based resuscitation Hypotension & hypoxemia management Rapid neurosurgical intervention required Extensive rehabilitation Novel approaches needed Prevention Monitoring Therapy Rehabilitation
Frequently encountered, often with blast injuries Complex patients Sepsis MOF Case #4: Pediatric Burns Require multiple surgeries Prolonged hospital stays Specialized pediatric equipment required Host nation challenges vs. care for US service members
Frequently encountered, very common in civilian world Complicated management Balancing transport imperatives with clinical stability Data loss in hand-offs Vascular injury Training deficiencies: general surgeons managing orthopedic, vascular injuries Materiel challenges Case #5: Blunt trauma
5 Meetings #1 May 2015: Introduction to the project #2 July 2015: The Military Trauma Care System Deployed military health system Evacuation chain Definitive care & rehabilitation Joint Trauma System #3 September 2015: Building & Maintaining the System Education & training Research & development Translation to practice #4 November 2015: Committee Report Planning #5 January 2016: Finalize Report Planning
Site Visit? Off-site meeting Need a full extra day (implies 3 days of committed time) Proposal: San Antonio POI care by medic at Camp Bullis Walk-through of mock-ups (Role 1, FST, CSH, C17) Visit to SAMMC, ISR Burn Unit, CFI ISR lab visit METC/AMEDD C&S
Questions?