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.
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. https://doi.org/10.17226/23511.
|Part I: Introduction, Overview, and Framework||35-36|
|2 Overview of Contemporary Civilian and Military Trauma Systems||73-118|
|3 A Framework for a Learning Trauma Care System||119-146|
|Part II: Assessment||147-148|
|4 Generating and Applying Knowledge to Improve Trauma Outcomes||149-232|
|5 Creating and Sustaining an Expert Trauma Care Workforce||233-270|
|6 Delivering Patient-Centered Trauma Care||271-300|
|7 Leveraging Leadership and Fostering a Culture of Learning||301-336|
|Part III: Recommendations||337-338|
|8 A Vision for a National Trauma Care System||339-380|
|Appendix A: Case Studies||383-428|
|Appendix B: Committee Collective Analysis of Case Studies||429-436|
|Appendix C: MilitaryCivilian Exchange of Knowledge and Practices in Trauma Care||437-448|
|Appendix D: Military and Civilian Trauma Care in the Context of a Continuously Learning Health System||449-458|
|Appendix E: Public Committee Meeting Agendas||459-474|
|Appendix F: Committee Biosketches||475-490|
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Trauma is the leading cause of death in the United States for those 46 and under. If trauma care were optimal, hundreds or more lives of our military service members could likely be saved in future wars. Those potential gains soar into the tens of thousands of lives saved if past and future improvements in military trauma care could be systematically translated into the civilian sector.
The National Academies of Sciences, Engineering, and Medicine report "A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury" presents a vision for a national trauma care system driven by the clear and bold aim of zero preventable deaths after injury and minimal trauma-related disability: to benefit those the nation sends into harm’s way in combat, as well as every American.
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