USAISR Receives FDA Approval for Compensatory Reserve Indicator

February 6th, 2017

Collaborating with other scientists and engineers, the U.S. Army Institute of Surgical Research developed an algorithm that measures the body’s ability to compensate for blood loss, or the compensatory reserve. The compensatory reserve index (CRI) can predict when a patient is about to go into hemorrhagic shock. The device, which takes readings from a standard pulse oximeter, received FDA clearance in December 2016.

USAISR researchers believe that combat medics attending to battlefield wounded, as well as civilian EMTs, can employ the device to save lives, as it can continuously monitor patients and provide a guide for fluid resuscitation and other interventions.

Read the full story.

CDC Reports on Higher Death Rates in Non-Metro Areas

January 17th, 2017

The January 13th edition of the CDC’s Morbidity and Mortality Weekly Report (MMWR) provides an assessment of the leading causes of death in non-metro and metro areas between 1999 and 2014, concluding that higher rates of death occur in non-metro areas of the U.S.

After calculating age-adjusted death rates and potentially excess death in metro and non-metro areas for the five leading causes of death–heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke–the CDC concluded that more than half of all deaths (57.5%) from unintentional injury, specifically, that occur outside metro areas were potentially excess (potentially preventable). In metro areas, that rate is 39.2%.

The report suggests the higher rate of excess death in more rural areas of the country may be related to a variety of factors including less access to health care services, further distance to trauma care centers, and reduced EMS services as well as behavioral factors like physical inactivity during leisure and lower use of seat belts.

“Routine tracking of potentially excess deaths in nonmetropolitan areas might help public health departments identify emerging health problems, monitor known problems, and focus interventions to reduce preventable deaths in these areas,” the report concludes.

NTI Board Member Gibran Earns Distinguished Alumna Award

January 9th, 2017

Dr. Nicole Gibran, professor and Director of the UW Medicine Regional Burn Center at Harborview Medical Center, has been honored by colleagues in the Alumni Association of Boston University School of Medicine (BUSM) with its Distinguished Alumna Award. This annual award will be presented to Dr. Gibran in recognition of the significant impact she has had in the medical field on a national and global scale. The award will be presented to Dr. Gibran at BUSM in May 2017.

Dr. Gibran is a member of the NTI Board of Directors, one of many positions of prominence she holds within the medical field.

Op-ed in JAMA Surgery Decries Limited Funding for Trauma Research

January 5th, 2017

Despite significant advances made in U.S. trauma care and systems over the past 50 years, traumatic injury continues to be an unacceptable and increasing societal burden, argues Kimberly Davis, MD, in an opinion piece published in JAMA Surgery in December. Davis is a professor in the Dept. of Surgery at Yale University and a member of the executive committee of CNTR, the Coalition for National Trauma Research. The National Trauma Institute is a member of CNTR.

Davis and co-authors Timothy Fabian, MD, and William Cioffi, MD, point to the lack of a centralized national home and stable funding stream for trauma research to explain how this public health problem has reached epidemic proportions. “…[S]ince 1966 the mortality rate has increased 0.66% per year,” they say. And the annual costs are astronomical: $214 billion for fatal traumatic injury and $457 billion for non-fatal injuries, including healthcare and lost productivity.

Davis et al. consider the billions of dollars in research funding directed toward Ebola and Zika–both serious public health issues in recent years, yet neither impacting the United States to any degree–and wonder about the lack of attention paid to trauma. “It is shocking that nearly 150,000 deaths every year do not warrant a similar response.”

Read the article. (doi:10.1001/jamasurg.2016.4625)

Senator-Elect Duckworth Calls for Better Integrated Trauma Care

November 23rd, 2016

In a Time magazine opinion piece, Illinois senator-elect Tammy Duckworth and Boston Marathon bombing victim Patrick Downes state their case for establishing a military-civilian trauma care partnership that can save lives.

As a U.S. House member, Duckworth introduced the National Trauma Care System Act this legislative session, which would enact many of the recommendations published in the June 2016 NASEM report, A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury.

Duckworth was traumatically injured when a rocket-propelled grenade hit the Black Hawk helicopter she was piloting over Iraq in 2004, and has championed trauma care and research throughout her tenure in Congress. Her commentary in Time magazine draws well-deserved public attention to this life or death issue.

Read the article.

Trial of Body Cooling Procedure Concludes–One Step Closer to Saving Lives

November 21st, 2016

The November 28, 2016 edition of The New Yorker reports that Baltimore’s Shock Trauma recently completed a trial of emergency preservation and resuscitation (EPR), a procedure that may be able to save patients who otherwise would die from exsanguination. It’s a procedure wherein the chest cavity of a bleeding patient is pumped full of ice-cold saline. The procedure drops the patient’s brain temperature into the lower fifties and puts the body into a state of suspended animation for up to an hour while surgeons can repair bullet holes and other injuries.

EPR “has long been proved successful in animal experiments, but overcoming the institutional, logistical, and ethical obstacles to performing it on a human being has taken more than a decade,” reports Nicola Twilley, author of The New Yorker article. Dr. Sam Tisherman directed the EPR trial–he began work related to the procedure while at the University of Pittsburgh. Continuing the work of Dr. Peter Safar, his mentor and one of the founding fathers of resuscitation science, Dr. Tisherman has been joined in his pursuit by many colleagues across the United States throughout the years.

“In the United States, between thirty and forty thousand people a year bleed to death from fixable injuries,” says Twilley. “Ultimately, if the technique does evolve as Tisherman envisages, it will simply become the next step for treatment after CPR has failed, used to buy time and prevent brain death.”

It will likely be two years before the results from the trial can be made public.

Read the full, amazing story about how the research unfolded over three decades to make this procedure possible.

NASEM Releases Video Illustrating Need for a National Trauma Care System

November 18th, 2016

To accompany its June 2016 report calling for improved trauma care in the U.S., the National Academies of Science, Engineering and Medicine created a video that briefly illustrates the report’s main messages. Advances in military  trauma care achieved during the Afghanistan and Iraq wars can be translated to the civilian sector to improve trauma care for all Americans, say the report’s authors. Sustaining these military advances, and closing the gap between the military and civilian sectors, can help to improve trauma care—to protect those the nation sends into harm’s way, and to benefit every American.

View the video HERE.

En Route Care and Training for Immediate Responders Explored in November JOT Supplement Covering 2015 MHSRS Proceedings

November 10th, 2016

Supplement 1 of the Journal of Trauma, Volume 81, No.5, carries multiple papers emanating from the 2015 Military Health System Research Symposium. Below are synopses of several. To read the entire supplement, click here.

Machine learning and new vital signs monitoring in civilian en route care: A systematic review of the literature and future implications for the military  

Researchers Nehmiah Liu and Jose Salinas, PhD, reviewed the existing literature related to machine learning (ML) algorithms (MLA) and new vital signs monitoring (NVSM) in civilian en route care in order to determine their potential to fill combat medicine capability gaps. Recent machine learning technologies include those that monitor novel vital signs such as heart rate variability (HRV) and heart rate complexity (HRC). In addition, the photopletysmograph wave form and data quality indices offer potential ways to evaluate the need for lifesaving interventions during en route care.

There continues to be limited means of monitoring and recording data in-flight–such as vital signs, waveforms or interventions made by in-flight personnel—and an imperative to leverage such data to improve care and reduce mortality. Thus, the researchers are optimistic that new innovations could be of benefit in combat scenarios, but caution that further validation is warranted before widespread use. “Almost all studies required further validation in prospective and/or randomized controlled trials,” they determined.

 

Combat MEDEVAC: A comparison of care by provider type for en route trauma care in theater and 30-day patient outcomes

A 2009 change in military combat medicine policy led to the integration of Air Force Pararescuemen with paramedic training into MEDEVAC missions in a bid to decrease mortality. Paramedic level training was thus incorporated into the initial flight medic training of DUSTOFF medics in 2012, and a new program course at Fort Sam Houston provided additional paramedic and critical care training to promote all skill competencies at the EMT–intermediate/paramedic level as well as CCFP certification.

Vikhyat Bebarta, MD, and other researchers at Fort Sam Houston sought to analyze the resulting reallocation of resources in order to determine whether the intended benefit had been attained. In this study, the researchers identified and described medical providers and their specific roles on MEDEVAC missions, and identified associations between provider type, procedures performed, medications administered, survival, and 30-day outcomes.

In a review of more than 1,200 records of US casualties between 2011 and 2014, they determined that 76% of MEDEVAC personnel were medics, 21% paramedics, and 4% were advanced-level providers (ADVs) including nurses, physicians, and physician assistants. Providers with higher-level training were more likely to perform more advanced procedures during en route care; however, there was no significant association between provider type and in-theater or 30-day mortality rates. “More evidence is needed to determine the appropriate level of MEDEVAC personnel training and skill maintenance necessary to minimize combat mortality,” the researchers concluded.

Liu and Salinas argue for research that advances these technologies for en route care. “Importantly, these innovations could not only enhance trauma casualty care for our nation’s war fighters in a complex global environment but also close gaps–specifically, monitoring and the early detection and treatment of various injuries,” say the researchers.

 

Improving national preparedness for mass casualty events: A seamless system of evidence-based care

Researchers Alexander Eastman, MD, William Fabbri, MD, Kathryn Brinsfield, MD, and Lenworth Jacobs, MD, argue in a special report that the U.S. lacks “a unified, coordinated national system to respond to intentional mass casualty attacks….”

The researchers note that our national preparedness goal is thwarted by segmented, compartmentalized, or simply unobtainable investigative, clinical, and medical examiner data following mass casualty events. The distributed nature of the ownership of various segments of the civilian health care system is to blame, they say, and the consequence is that “conjecture, bias, and anecdote inform the civilian section of our national response rather than scientific evidence.”

The Hartford Consensus, they contend, is one attempt to evaluate evidence-based approaches to the problem. The authors review recommendations from successive Hartford Consensus meetings and conclude that immediate responders to mass casualty events, employing bleeding control techniques, hold the key to national resilience. Immediate responders, as defined, include law enforcement officers, bystanders, and even victims.

“Our military colleagues have demonstrated that a robust data collection system, organized scientific study of the problem, and system-wide implementation of evidence-based solutions can significantly improve survival from intentional traumatic injury,” Eastman et al. conclude. “Our duty now is to build the foundations of an analogous civilian system in order to begin to answer the remaining questions and to truly improve our national preparedness.”

New Book Celebrates the Progress of Trauma Care in America

November 7th, 2016

Dr. Catherine Musemeche is a student of medical history and a former pediatric surgeon who weaves vivid personal anecdotes throughout her comprehensive telling of the evolution of trauma care in America—from the Civil War through the conflicts in Iraq and Afghanistan.

Recently published by University Press of New England, HURT—The Inspiring, Untold Story of Trauma Care reads like an adventure story, complete with compelling prose and action-packed portraits of real-life heroes like R Adams Cowley, James Styner, Deke Farrington, Sue Baker, John Paul Stapp and plenty of others. HURT is both a celebration of how far the trauma care system has traveled in an astonishingly short amount of time and a reminder of what is left to accomplish.

A board-certified Fellow of the American College of Surgeons, Dr. Musemeche and has flown on rescue helicopters, trained and practiced in trauma centers in Houston and Chicago and operated on hundreds of trauma victims of all ages. Her work is meticulously cited and includes references to articles by Thomas Scalea, Martin Croce, David Livingston, Brent Eastman and many others with whom the trauma care community is very familiar.

This is a great book for ER residents, aspiring trauma surgeons, nurses or anyone in the medical field who is interested in knowing about the history of the U.S. trauma system and standards. Order a copy today, or catch Dr. Musemeche’s next book reading at BookWoman in Austin, TX on Saturday, November 26 at 1:00 p.m. Check the BookWoman calendar for updates.

NIH For Trauma Necessary to Support Civilian Acute Care Needs

October 20th, 2016

In an article published in The New England Journal of Medicine, Todd Rasmussen, MD (DoD Combat Casualty Research Program) and Arthur Kellerman, MD (Uniformed Services University of the Health Sciences) propose the establishment of an NIH institute dedicated to trauma and emergency care research.

DoD funding represents more than 80 percent of the federal government’s annual investment in trauma care research, the authors point out. “Although this arrangement ensures the military relevance of federal research on trauma care, it provides little support for civilian priorities and leaves the field overly dependent on DoD funding.”

Rasmussen and Kellerman reference the June 2016 report from the National Academies of Science, Engineering and Medicine, which calls for a National Trauma Action Plan that integrates civilian and military trauma care capabilities. Establishing an NIH for trauma, they contend, will help to “drive the number of preventable deaths after injury down to zero.”

Read the article.