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A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury (2016)

Chapter: Appendix C: MilitaryCivilian Exchange of Knowledge and Practices in Trauma Care

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Suggested Citation:"Appendix C: MilitaryCivilian Exchange of Knowledge and Practices in Trauma Care." National Academies of Sciences, Engineering, and Medicine. 2016. A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. Washington, DC: The National Academies Press. doi: 10.17226/23511.
×

C Military–Civilian Exchange of Knowledge and Practices in Trauma Care1

The exchange of knowledge and practices between the military and civilian sectors was seamless through World War II—civilian surgeons were activated for combat deployment and then returned to civilian practice with their lessons learned. Significant changes in military medical staffing over subsequent decades have led to an all-volunteer medical force with little trauma experience practicing largely in nontrauma hospitals. Because most deploying surgeons, allied medical specialists (e.g., in anesthesia, radiology, and emergency medicine), allied support specialists (e.g., blood bank, pharmacy, and administration personnel), nurses, and medics are not experts in trauma care and do not regularly practice in that field, brief predeployment training courses have minimal impact on their expertise. Postdeployment, they then return to the military sector, relatively isolated from the civilian trauma community. Furthermore, the episodic nature of military trauma care, with periods of intense action separated by many years, results in a “peacetime effect” in which the process of combat casualty care must be recreated almost from scratch every time combat operations escalate.

Because the civilian and military health systems are now largely segregated, scientific meetings and medical journals have become important

__________________

1 This appendix is excerpted from a paper commissioned by the National Academies of Sciences, Engineering, and Medicine Committee on Military Trauma Care’s Learning Health System and Its Translation to the Civilian Sector, written by Jeremy W. Cannon, Perelman School of Medicine, University of Pennsylvania. The paper in its entirety is available on the study website at nationalacademies.org/TraumaCare.

Suggested Citation:"Appendix C: MilitaryCivilian Exchange of Knowledge and Practices in Trauma Care." National Academies of Sciences, Engineering, and Medicine. 2016. A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. Washington, DC: The National Academies Press. doi: 10.17226/23511.
×

venues for the exchange of knowledge and practices. However, it may be argued that although these exchanges are important and necessary, they are not sufficient. Attendance of civilian experts at military conferences is quite limited, and military members’ attendance at civilian conferences is routinely threatened by various contingencies. Furthermore, dissemination of knowledge through the medical literature is notoriously slow, taking on average up to 17 years (IOM, 2001).

More optimal exchange of knowledge and practices occurs in select military treatment facility (MTF) trauma centers and integrated military–civilian training sites where regular interaction with civilian counterparts takes place. Over the past decade, first-hand interactions between military surgeons and civilian trauma and vascular experts through the Senior Visiting Surgeon (SVS) Program also demonstrated significant value for both the military and civilian communities, although the future of this program or its replacement remains unclear.

At present, the challenges to maintaining consistent practice in combat casualty care, gaining knowledge on the quality of care, and exchanging that knowledge with the civilian sector and vice versa are myriad. The vast complexity of the Military Health System (Schwab, 2015), along with frequent turnover at all levels, creates an inherently unstable system. This reality makes consistency in routine matters difficult, much less the preservation of lessons learned across decades of practice and multiple generations of military physicians. Furthermore, an artificial division exists in who is responsible for the care of patients prehospital and once they reach medical care. The military “line” (i.e., nonmedical forces) rather than the medical corps controls all aspects of the prehospital environment. The result has been significant barriers to collecting prehospital data and understanding the causes of prehospital deaths (i.e., killed in action). Finally, significant legal and policy limitations hinder the involvement of combat-experienced civilian physicians as trainers, educators, and advisors to the military (e.g., the Committee on Tactical Combat Casualty Care). All of these factors result in a highly volatile, internally fragmented system that is stovepiped from external influences and input. It is no wonder that the same mistakes are repeated and the case fatality rate rises significantly at the beginning of each war.

The infrastructure of the Joint Trauma System (JTS) (Bailey et al., 2012; Butler et al., 2015) and the pledge of partnership and collaboration between the American College of Surgeons and the Military Health System (ACS, 2014) represent ideal starting points for addressing the weaknesses identified above. These changes will doubtless benefit both combat casu-

Suggested Citation:"Appendix C: MilitaryCivilian Exchange of Knowledge and Practices in Trauma Care." National Academies of Sciences, Engineering, and Medicine. 2016. A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. Washington, DC: The National Academies Press. doi: 10.17226/23511.
×

alties and injured civilians. Table C-1 details a number of recommended courses of action for addressing the weaknesses of the current system. The underlying premise behind these recommendations is that military–civilian exchange needs to begin at the earliest stages of medical education. Then in residency and during active practice, although civilian trauma care may be an imperfect training platform for military deployment (Smith and Hazen, 1991), immersion in this environment is far superior to no or very limited trauma care training and experience (Livingston et al., 2014; Sambasivan et al., 2010; Schreiber et al., 2008). This same conclusion was reached years ago by many U.S. allies, which routinely house deployment-eligible military medical units entirely in the reserves or on active duty embedded within high-volume civilian trauma centers (DuBose et al., 2012; Soffer and Klausner, 2012). The first step in this direction is to delineate the critical wartime specialties and the numbers needed in each specialty, and then to ensure that combat-designated military physicians, nurses, and medics are immersed in full-time trauma care either in an MTF trauma center or a high-volume, high-acuity civilian center (Schwab, 2015). Ideally, these personnel would work together as a unit and would also deploy as a unit for optimal effectiveness (Kellicut et al., 2014; Thorson et al., 2012). These units would then contribute lessons learned to the learning health system, which could be modeled after the Center for Army Lessons Learned (Dixon, 2011; USACAC, 2016). Review of these lessons learned and implementation of actionable change could then be effected through the JTS or a newly established military think tank under the auspices of Uniformed Services University of the Health Sciences or the Defense Health Agency (Eiseman and Chandler, 2005; Schwab, 2015).

Suggested Citation:"Appendix C: MilitaryCivilian Exchange of Knowledge and Practices in Trauma Care." National Academies of Sciences, Engineering, and Medicine. 2016. A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. Washington, DC: The National Academies Press. doi: 10.17226/23511.
×

TABLE C-1 Military–Civilian Exchange of Knowledge and Practices: Strengths, Weaknesses, and Opportunities

  STRENGTHS WEAKNESSES
Undergraduate medical education—Uniformed Services University of the Health Sciences (USUHS)
  • Early exposure to military medical history
  • Limited exposure to civilian experts, which continues into residency (most USUHS graduates are obligated to undergo military residency)
Undergraduate medical education—Health Professions Scholarship Program (HPSP)
  • Potential for exposure to national and international experts in multiple fields
  • Students may attend any medical school regardless of the quality
  • Little to no exposure to military medical history
  • Required military rotations are not required to have readiness relevance
Undergraduate nursing education
  • Exposure to civilian thought leaders and potential mentors
  • No military medical curriculum
Military medic education and training
  • Heavy emphasis on prehospital trauma stabilization
  • Disconnect between scope of practice during deployment and in garrison
  • Little exposure to civilians in comparable positions
  • No requirement for patient contact prior to deployment
Residency/fellowship—military
  • Exposure to staff with deployment experience
  • Education in readiness-relevant topics and Joint Trauma System (JTS) clinical practice guidelines (CPGs)
  • No opportunity to deploy even for an elective rotation (some residents have completed Landstuhl Regional Medical Center [LRMC] rotations)
  • Low-volume/low-acuity training with some exceptions (e.g., San Antonio Military Medical Center [SAMMC] in Trauma+Surgical Critical Care)
  • Military regulations now limit meeting attendance
Residency/fellowship—civilian (sponsored or deferred)
  • Potential for exposure to national and international experts
  • Trauma+Surgical Critical Care: exposure to critical clinical and systems-based practice concepts
  • Little to no exposure to military physicians or military-specific topics
Suggested Citation:"Appendix C: MilitaryCivilian Exchange of Knowledge and Practices in Trauma Care." National Academies of Sciences, Engineering, and Medicine. 2016. A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. Washington, DC: The National Academies Press. doi: 10.17226/23511.
×
RECOMMENDATIONS
  • Require a minimum of one civilian rotation for USUHS students in an approved specialty at approved locations
  • Utilize the same standards as for the Yellow Ribbon undergraduate program (medical schools should actively compete for military scholarship students)a
  • HPSP students should learn military medical history (e.g., USUHS course) and should perform at least one deployment-relevant clinical rotation
  • Develop a basic military nursing curriculum for the Reserve Officers’ Training Corps (ROTC) and those seeking loan repayment
  • Seek special training exemptions that allow medics to prepare in skills that are within their deployment scope of practice
  • Establish more civilian training sites for military medics
  • Require that medics perform and maintain hands-on patient skills
  • Residents in combat-designated specialties should perform at least one rotation as a senior resident (scheduled during an elective block) in a forward location (Level III or IV facility) or military trauma center
  • Critically evaluate the case mix and volume in nontrauma military treatment facility (MTF) residency programs
  • Repeal the current restrictive policy to encourage military–civilian exchange at the resident-fellow level
  • Residents in combat-designated specialties should perform at least one rotation as a senior resident (scheduled during an elective block) in a trauma MTF and another rotation in a forward location (Level III or IV facility)
Suggested Citation:"Appendix C: MilitaryCivilian Exchange of Knowledge and Practices in Trauma Care." National Academies of Sciences, Engineering, and Medicine. 2016. A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. Washington, DC: The National Academies Press. doi: 10.17226/23511.
×
  STRENGTHS WEAKNESSES
Military physicians in practice—nontrauma MTF  
  • Stovepiped from civilian physicians if at an MTF (except through off-duty employment [ODE])
  • Little overlap between regular and deployed practice
  • Low-volume/low-acuity practice with little exposure to trauma
  • Lessons learned in combat are not disseminated to civilians
  • Military regulations now limit meeting attendance
  • Nursing readiness/trauma skills only episodically maintained
Military physicians in practice—trauma MTF
  • Diverse exposure to high-acuity military and civilian trauma patients (SAMMC)
  • SAMMC: Co-located with the JTS and U.S. Army Institute of Surgical Research (USAISR)
  • Walter Reed National Military Medical Center (WRNMMC): Collocated with USUHS and Walter Reed Army Institute of Research (WRAIR)
  • Interaction with members of the American College of Surgeons Committee on Trauma (ACS COT)
  • Diverse research opportunities
  • Frequent civilian visiting professors
  • Emergency War Surgery Course (EWSC) and ACS-endorsed courses taught frequently
  • Some do not permit care of civilian patients (WRNMC, LRMC)
  • Military regulations now limit meeting attendance
  • No incentive for combat-essential specialists to remain current in trauma
Military physicians in practice—civilian training center cadre
  • Immersion in high-volume, high-acuity trauma practice with civilian experts
  • Robust experience for multiple specialties, nurses, and medics
  • Cadre typically does not deploy
  • One site does not fully credential cadre (Army Trauma Training Center [ATTC])
  • No external validation of training consistency and quality
Suggested Citation:"Appendix C: MilitaryCivilian Exchange of Knowledge and Practices in Trauma Care." National Academies of Sciences, Engineering, and Medicine. 2016. A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. Washington, DC: The National Academies Press. doi: 10.17226/23511.
×
RECOMMENDATIONS
  • Combat-designated physicians, nurses, and medics should be assigned to trauma MTFs or to selected high-volume, high-acuity civilian trauma centers
  • Utilize the Center for Army Lessons Learned (CALL) (or comparable system) to capture and disseminate lessons learned to other military members and to the civilian sector
  • Repeal the current restrictive policy to encourage military–civilian exchange at the staff level
  • Expand the Secretary of Army/Navy/Air Force programs to permit care of civilian trauma patients
  • Consider designating additional Army, Navy, and Air Force MTFs as trauma centers
  • Repeal the current restrictive policy to encourage military–civilian exchange at the staff level
  • Consider a “combat-designated” pay incentive
  • Provide additional staffing to permit cadre to deploy
  • All sites should fully credential qualified staff surgeons
  • Institute reporting requirements and JTS verification reviews of training sites
  • Consider a “combat-designated” pay incentive
Suggested Citation:"Appendix C: MilitaryCivilian Exchange of Knowledge and Practices in Trauma Care." National Academies of Sciences, Engineering, and Medicine. 2016. A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. Washington, DC: The National Academies Press. doi: 10.17226/23511.
×
  STRENGTHS WEAKNESSES
National Guard/Reserves
  • Immersed in civilian practice which generally affords a robust and diverse clinical experience
  • Immediate translation of lessons learned back to the civilian sector
  • Deployment experience valuable for civilian disaster response
  • Clinical practice experience can be variable and may not be combat-relevant
Predeployment training—civilian training sites
  • High-quality educational offerings at all five sites
  • Deployment-experienced cadre
  • Students are expected to be experts in trauma care at the end of 2–4 weeks
  • Very few deploying teams and physicians pass through any of these sites despite in-place requirements
ACS sponsored courses
  • Many with readiness relevance
  • Military members have contributed modules
  • Some are prohibitively expensive
  • Combat-relevant modules needed in some courses
Pre-deployment training—EWSC
  • Most frequently taken predeployment course
  • Compact, high-yield course
  • Includes ACS-endorsed course material
  • Operational modules add relevance
  • Nurse education track in parallel
  • Challenging to maintain standardized material with multiple sites offering and little administrative support
  • Students are expected to be experts in trauma care at the end of 3 days
  • Little to no civilian input aside from ACS-endorsed content
Senior Visiting Surgeon Program
  • 192 trauma and vascular surgeons spent 2–4 weeks providing expert consultation and clinical coverage at LRMC or downrange
  • Many gave expert grand rounds lectures
  • Research mentorship for military surgeons
  • Only selected trauma surgeons able to participate
  • No clear plan or directive for continuing this program
Professional societies and conferences—civilian
  • Many have provided robust military support
  • Some have military committees
  • New ACS–Military Health System (MHS) partnership promising for sustained military–civilian exchange
  • Attendance has been curtailed by military regulations
  • Few have dedicated military sessions
Suggested Citation:"Appendix C: MilitaryCivilian Exchange of Knowledge and Practices in Trauma Care." National Academies of Sciences, Engineering, and Medicine. 2016. A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. Washington, DC: The National Academies Press. doi: 10.17226/23511.
×
RECOMMENDATIONS
  • The JTS should validate the practice of the Guard and Reserve combat-designated specialists
  • Consider a “combat-designated” pay incentive
  • Rotators should come through for refresher training with significant prior experience and expertise in trauma
  • In the reorganization, only combat-designated teams should pass through for a final “check ride”
  • Liberalize staff:student ratio for experienced students (i.e., attending surgeons)—Advanced Trauma Operative Management (ATOM)
  • Encourage military members to develop modules
  • Require that EWSC be kept current and that all sites use this version; provide additional administrative support
  • Students should come through for refresher training with significant prior experience and expertise in trauma
  • Seek civilian consultants to contribute to EWSC content
  • Make participation in this program a competitive application reviewed by the JTS, ACS, American Association for the Surgery of Trauma (AAST), and Society for Vascular Surgery
  • Continue the program in some form negotiated among all stakeholders
  • Repeal the current restrictive policy to encourage military–civilian exchange at the staff level
  • Advocate for dedicated military sessions
  • Include military members in society leadership and governance
Suggested Citation:"Appendix C: MilitaryCivilian Exchange of Knowledge and Practices in Trauma Care." National Academies of Sciences, Engineering, and Medicine. 2016. A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. Washington, DC: The National Academies Press. doi: 10.17226/23511.
×
  STRENGTHS WEAKNESSES
Professional societies and conferences—military
  • Important forum for dissemination of military research results to other military centers
  • Few civilian attendees
  • Research quality is variable
  • The Association of Military Surgeons of the United States (AMSUS) currently places little emphasis on deployment medicine
Professional journals
  • Military supplements in Journal of Trauma and Acute Care Surgery and Shock
  • These are high-impact articles
  • New technology makes these references readily available
  • No military editors in top journals
  • Historically difficult to access or ignored
  • Difficult to determine which recommendations represent standard practice
Research funding and protocols
  • Military funds significant numbers of trauma-specific research protocols (gap-driven)
  • USAISR and WRAIR have both military and civilian research personnel
  • Intramural protocols typically have mostly or only military investigators
  • Extramural protocols typically have mostly or only civilian investigators
  • Imbalance between burden of disease and available funds in both the National Institutes of Health (NIH) and U.S. Department of Defense (DoD) research budgets
JTS CPGs
  • Repository of most current best practices in military trauma care
  • Housed and updated by the JTS
  • Some relevant topics not covered
  • CPG development does not adhere to systematic review standards
  • Little to no external validation or civilian review/input
Recently separated or retired military physicians, nurses, and medics
  • Wealth of knowledge and experience
  • Many go on to serve as civilians in MTFs or U.S. Department of Veterans Affairs Medical Centers (VAMCs)
  • No mechanism for formally interfacing with military personnel who are facing deployment

a Information on the Yellow Ribbon Program is available from http://www.benefits.va.gov/gibill/yellow_ribbon/yellow_ribbon_info_schools.asp (accessed May 23, 2016).

Suggested Citation:"Appendix C: MilitaryCivilian Exchange of Knowledge and Practices in Trauma Care." National Academies of Sciences, Engineering, and Medicine. 2016. A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. Washington, DC: The National Academies Press. doi: 10.17226/23511.
×
RECOMMENDATIONS
  • Improve conference quality to attract civilian attendees
  • Include civilians in society leadership and governance
  • Be more selective in abstract acceptance
  • Add a readiness element to AMSUS
  • Encourage military associate editorial positions
  • Look to CPGs for clarification
  • Require military and civilian investigators on all DoD-funded grants
  • Promote increased federal and private funding for injury-related research
  • Conduct regular CPG reviews using the Delphi method involving both military and civilian experts
  • Consider adding systematic review experts to the JTS staff
  • Require that each CPG have at least one civilian reviewer
  • Establish a formal mechanism for physicians, nurses, and medics who have valuable wartime skills and experience to interface with the next generation of deploying medical professionals
  • Create means for deployed team members to seek advice or consultation from combat-experienced individuals who are no longer in the military
Suggested Citation:"Appendix C: MilitaryCivilian Exchange of Knowledge and Practices in Trauma Care." National Academies of Sciences, Engineering, and Medicine. 2016. A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. Washington, DC: The National Academies Press. doi: 10.17226/23511.
×

REFERENCES

ACS (American College of Surgeons). 2014. American College of Surgeons announces strategic partnership with the Military Health System. https://www.facs.org/media/pressreleases/2014/dod1014 (accessed February 21, 2016).

Bailey, J., S. Trexler, A. Murdock, and D. Hoyt. 2012. Verification and regionalization of trauma systems: The impact of these efforts on trauma care in the United States. Surgical Clinics of North America 92(4):1009-1024, ix-x.

Butler, F. K., D. J. Smith, and R. H. Carmona. 2015. Implementing and preserving the advances in combat casualty care from Iraq and Afghanistan throughout the US military. Journal of Trauma and Acute Care Surgery 79(2):321-326.

Dixon, N. M. 2011. A model lessons learned system—the US Army. http://www.nancydixonblog.com/2011/02/a-model-lessons-learned-system-the-us-army.html (accessed February 21, 2016).

DuBose, J., C. Rodriguez, M. Martin, T. Nunez, W. Dorlac, D. King, M. Schreiber, G. M. D. Vercruysse, H. Tien, A. Brooks, N. Tai, M. Midwinter, B. Eastridge, J. Holcomb, B. Pruitt, and Eastern Association for the Surgery of Trauma Military Ad Hoc Committee. 2012. Preparing the surgeon for war: Present practices of US, UK, and Canadian militaries and future directions for the US military. Journal of Trauma and Acute Care Surgery 73(6 Suppl. 5):S423-S430.

Eiseman, B., and J. G. Chandler. 2005. Time for the Uniformed Services University of the Health Sciences (USUHS) to raise its sights. World Journal of Surgery 29(1):S51-S54.

IOM (Institute of Medicine). 2001. Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.

Kellicut, D. C., E. J. Kuncir, H. M. Williamson, P. C. Masella, and P. E. Nielsen. 2014. Surgical team assessment training: Improving surgical teams during deployment. American Journal of Surgery 208(2):275-283.

Livingston, D. H., R. F. Lavery, M. C. Lopreiato, D. F. Lavery, and M. R. Passannante. 2014. Unrelenting violence: An analysis of 6,322 gunshot wound patients at a Level I trauma center. Journal of Trauma and Acute Care Surgery 76(1):2-9.

Sambasivan, C. N., S. J. Underwood, S. D. Cho, L. N. Kiraly, G. J. Hamilton, J. T. Kofoed, S. F. Flaherty, W. C. Dorlac, and M. A. Schreiber. 2010. Comparison of abdominal damage control surgery in combat versus civilian trauma. Journal of Trauma 69(Suppl. 1):S168-S174.

Schreiber, M. A., K. Zink, S. Underwood, L. Sullenberger, M. Kelly, and J. B. Holcomb. 2008. A comparison between patients treated at a combat support hospital in Iraq and a Level I trauma center in the United States. Journal of Trauma 64(Suppl. 2):S118-S121.

Schwab, C. W. 2015. Winds of war: Enhancing civilian and military partnerships to assure readiness: White paper. Journal of the American College of Surgeons 221(2):235-254.

Smith, A. M., and S. J. Hazen. 1991. What makes war surgery different? Military Medicine 156(1):33-35.

Soffer, D., and J. M. Klausner. 2012. Trauma system configurations in other countries: The Israeli model. Surgical Clinics of North America 92(4):1025-1040, x.

Thorson, C. M., J. J. DuBose, P. Rhee, T. E. Knuth, W. C. Dorlac, J. A. Bailey, G. D. Garcia, M. L. Ryan, R. M. Van Haren, and K. G. Proctor. 2012. Military trauma training at civilian centers: A decade of advancements. Journal of Trauma and Acute Care Surgery 73(6 Suppl. 5):S483-S489.

USACAC (U.S. Army Combined Arms Center). 2016. Center for Army Lessons Learned. http://usacac.army.mil/organizations/mccoe/call (accessed February 21, 2016).

Suggested Citation:"Appendix C: MilitaryCivilian Exchange of Knowledge and Practices in Trauma Care." National Academies of Sciences, Engineering, and Medicine. 2016. A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. Washington, DC: The National Academies Press. doi: 10.17226/23511.
×
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Suggested Citation:"Appendix C: MilitaryCivilian Exchange of Knowledge and Practices in Trauma Care." National Academies of Sciences, Engineering, and Medicine. 2016. A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. Washington, DC: The National Academies Press. doi: 10.17226/23511.
×
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Suggested Citation:"Appendix C: MilitaryCivilian Exchange of Knowledge and Practices in Trauma Care." National Academies of Sciences, Engineering, and Medicine. 2016. A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. Washington, DC: The National Academies Press. doi: 10.17226/23511.
×
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Suggested Citation:"Appendix C: MilitaryCivilian Exchange of Knowledge and Practices in Trauma Care." National Academies of Sciences, Engineering, and Medicine. 2016. A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. Washington, DC: The National Academies Press. doi: 10.17226/23511.
×
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Suggested Citation:"Appendix C: MilitaryCivilian Exchange of Knowledge and Practices in Trauma Care." National Academies of Sciences, Engineering, and Medicine. 2016. A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. Washington, DC: The National Academies Press. doi: 10.17226/23511.
×
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Suggested Citation:"Appendix C: MilitaryCivilian Exchange of Knowledge and Practices in Trauma Care." National Academies of Sciences, Engineering, and Medicine. 2016. A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. Washington, DC: The National Academies Press. doi: 10.17226/23511.
×
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Suggested Citation:"Appendix C: MilitaryCivilian Exchange of Knowledge and Practices in Trauma Care." National Academies of Sciences, Engineering, and Medicine. 2016. A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. Washington, DC: The National Academies Press. doi: 10.17226/23511.
×
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Suggested Citation:"Appendix C: MilitaryCivilian Exchange of Knowledge and Practices in Trauma Care." National Academies of Sciences, Engineering, and Medicine. 2016. A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. Washington, DC: The National Academies Press. doi: 10.17226/23511.
×
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Suggested Citation:"Appendix C: MilitaryCivilian Exchange of Knowledge and Practices in Trauma Care." National Academies of Sciences, Engineering, and Medicine. 2016. A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. Washington, DC: The National Academies Press. doi: 10.17226/23511.
×
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Suggested Citation:"Appendix C: MilitaryCivilian Exchange of Knowledge and Practices in Trauma Care." National Academies of Sciences, Engineering, and Medicine. 2016. A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. Washington, DC: The National Academies Press. doi: 10.17226/23511.
×
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Suggested Citation:"Appendix C: MilitaryCivilian Exchange of Knowledge and Practices in Trauma Care." National Academies of Sciences, Engineering, and Medicine. 2016. A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. Washington, DC: The National Academies Press. doi: 10.17226/23511.
×
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Suggested Citation:"Appendix C: MilitaryCivilian Exchange of Knowledge and Practices in Trauma Care." National Academies of Sciences, Engineering, and Medicine. 2016. A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury. Washington, DC: The National Academies Press. doi: 10.17226/23511.
×
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Next: Appendix D: Military and Civilian Trauma Care in the Context of a Continuously Learning Health System »
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Advances in trauma care have accelerated over the past decade, spurred by the significant burden of injury from the wars in Afghanistan and Iraq. Between 2005 and 2013, the case fatality rate for United States service members injured in Afghanistan decreased by nearly 50 percent, despite an increase in the severity of injury among U.S. troops during the same period of time. But as the war in Afghanistan ends, knowledge and advances in trauma care developed by the Department of Defense (DoD) over the past decade from experiences in Afghanistan and Iraq may be lost. This would have implications for the quality of trauma care both within the DoD and in the civilian setting, where adoption of military advances in trauma care has become increasingly common and necessary to improve the response to multiple civilian casualty events.

Intentional steps to codify and harvest the lessons learned within the military’s trauma system are needed to ensure a ready military medical force for future combat and to prevent death from survivable injuries in both military and civilian systems. This will require partnership across military and civilian sectors and a sustained commitment from trauma system leaders at all levels to assure that the necessary knowledge and tools are not lost.

A National Trauma Care System defines the components of a learning health system necessary to enable continued improvement in trauma care in both the civilian and the military sectors. This report provides recommendations to ensure that lessons learned over the past decade from the military’s experiences in Afghanistan and Iraq are sustained and built upon for future combat operations and translated into the U.S. civilian system.

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