A National Trauma Care System Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury (2016) / Chapter Skim
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6 Delivering Patient-Centered Trauma Care
6 Delivering Patient-Centered Trauma Care
Pages 271-300
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Only a trauma care system structured around the patient experience, one that considers and actively engages the patient, family, and community, can achieve optimal short- and long-term outcomes for injured patients. This chapter analyzes the extent to which military and civilian trauma systems have adopted a patient-centered approach, identifying gaps and opportunities to improve.
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. This served not only as a performance improvement mechanism, but also afforded care providers at receiving treatment facilities a deeper understanding of earlier patient management strategies.
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Examples of efforts to expand the military trauma system to incorporate multi isciplinary, state-of-the-art rehabilitation are the advanced rehabili d tation programs located at the three military treatment facilities that treat a large proportion of the most severe combat casualties: the enter for the C I ntrepid in San Antonio, Texas; the Military Advanced Training Center at 2 In this context, evacuation times were defined as time elapsed from initial call to arrival at the treatment facility (Kotwal et al., 2016)
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provides an integrated continuum of rehabilitation services to address the physical and mental health needs of veterans and service members with impairments resulting from polytrauma and traumatic brain injury. The PSC coordinates and d elivers care at a variety of sites across the United States, linking specialized rehabilitation services provided at regional referral centers, network sites, and VA facilities (VA, 2016b)
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Second, access to rehabilitative care for wounded service members is not limited by insurance coverage. In the civilian sector, however, lack of access to high-quality rehabilitative care for uninsured and underinsured individuals has been associated with poorer long-term outcomes for trauma patients (Davidson et al., 2011; Mackersie, 2014)
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. Trauma patients who have been hospitalized for serious injuries are at high risk for posttraumatic stress disorder (PTSD)
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, it is important to continue providing proactive support and monitoring for symptoms throughout the post-acute care period. A holistic approach to the care of trauma survivors means integrating supportive behavioral health efforts with the treatment and restoration of 7 A comprehensive evaluation of screening tools and treatment options for PTSD and other mental health sequelae of traumatic injury is beyond the scope of this report.
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The task force's report formally describes the severe injury pattern as dismounted complex blast injury (DCBI) , characterized by traumatic amputation of at least one leg; severe injury to another extremity; and pelvic, abdominal, or urogenital wounding (DCBI Task Force, 2011)
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. Similar collaborative care approaches that link trauma survivors to evidence-based behavioral health services have been implemented in military and civilian trauma centers (see Box 6-2)
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C5 also offers mental health assessment and treatment, including specialized treatment programs for mild traumatic brain injury and posttraumatic stress disorder (PTSD)
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pain management guidelines and the use of oral transmucosal fentanyl8 (fentanyl lollipops) to deliver rapid pain control on the battlefield (DCBI Task Force, 2011)
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. The Defense and Veterans Center for Integrative Pain Management, located within the Uniformed Services University of the Health Sciences, was established in 2003 to improve pain management in military and civilian sectors through research and policy (DVCIPM, 2016)
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. Pediatric support for in-theater hospitals has seen improvement, including the development of a pediatric critical care teleconsultation service and the addition of pediatric information to clinical practice guidelines, but numerous challenges to providing advanced care for pediatric patients in the deployed setting remain ( orgman et al., 2012; Burnett et al., 2008)
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In 2014, approximately 10,000 children and adolescents died as a result of traumatic injury (NCIPC, 2015a)
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military's ability to provide advanced care to pediatric trauma patients in the deployed setting. Research on optimal clinician training, configuration of equipment sets, and systems-level integration of host national pediatric trauma care into the overall DoD trauma system represent opportunities for further refinement of expeditionary medicine.
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. Despite the prominence of pediatric trauma and efforts to promote readier access to specialized pediatric care, very limited research is currently available on pediatric trauma and the unique care preferences and needs of pediatric trauma patients (Upperman et al., 2010)
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. Better understanding is needed of what older trauma patients want from their care in terms of location, continuity, and resources in order to ensure that the care they receive aligns with both what they want and with what they need physiologically.
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. After suffering a traumatic injury such as a gunshot wound, patients injured in that part of the city need to be transported several miles in city traffic to reach the nearest trauma center.
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. In the military, for example, one report documents soldiers developing "do not resuscitate" pacts with their fellow service members in the event of a particularly damaging traumatic injury (DCBI Task Force, 2011)
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. A number of patient and family advisory councils have been established in civilian trauma centers (Willis et al., 2013)
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The education she provided over the next 3 months led to changes in pain management practices in all ICUs at Parkland. Another example of engaging trauma patients and their families in education occurred in 2005.
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SUMMARY OF FINDINGS AND CONCLUSIONS CONCLUSION: A patient-centered approach to trauma care is necessary to achieve optimal immediate-, near-, and long-term outcomes for trauma patients. Thus, it is essential for military and civilian trauma systems to
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2016. Pediatric Trauma Quality Improvement Program.
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2008. Undertriage of elderly trauma patients to state-designated trauma centers.
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2012. Dismounted complex blast injury report of the Army Dismounted Complex Blast Injury Task Force.
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Long term outcome of trauma patients admitted to the surgical intensive care unit. Journal of Trauma 67(2)
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2008. Impact of gender on outcomes after blunt injury: A definitive analysis of more than 36,000 trauma patients.
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2000. Impact of pediatric trauma centers on mortality in a statewide system.
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2006. Sex differences in trauma and posttraumatic stress disorder: A quantitative review of 25 years of research.
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2008. A national US study of posttraumatic stress disorder, depression, and work and functional outcomes after hospitalization for traumatic injury.
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