are performed at medical centers and clinics throughout the country, and the results of those studies are constantly reported in the open literature. A group or groups that would organize trauma studies suitable for multicenter implementation at existing trauma centers have the potential to address important questions and generate valuable data. A funding mechanism would be needed to cover the costs of the research that would be above and beyond the costs of care already expended for these patients.
Military-civilian research and education opportunities should be expanded and facilitated. The Civilian Level I and Level II Trauma Centers have the potential to evaluate outcomes and costs, to transport trauma patients, and to score the severity of injuries. Although severe limitations on the comparability of the civilian and military situations exist, the best available models are the civilian trauma centers. Progress in the civilian sector, for example, has had military applications in the following areas:
Civilian trauma centers should be used as an educational resource for military residency programs as well as for continuing medical education (CME) for career officers.
The committee found that much of the earlier work in the field of traumatic shock has been tainted by the failure to recognize the differences between pure hemorrhagic shock and traumatic shock associated with tissue injury, the failure to standardize animal models with regard to anesthesia, and the failure to observe subjects for longer-term survival. Clinical research has been hampered by the lack of an organized national approach to trauma research that takes advantage of the considerable clinical material and research expertise among the regional trauma centers. Advances in the treatment of traumatic shock will be enhanced significantly by improved approaches to research performed in studies with both animals and humans.
More specifically, the committee found that animal models in shock research have been broadly selected for convenience or availability rather than specific species-related reasons. It also found that the period of observation has been too short to justify the drawing of any conclusions about survival or mortality. Furthermore, although the use of anesthesia is appropriate for invasive protocols with animals, there is strong evidence that inhalational and intravenous anesthetics as well as many related drugs produce alterations in baseline cardiovascular functions. In addition, they inhibit the physiologic responses to hemorrhage in a significant way.