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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Appendix C: MilitaryCivilian Exchange of Knowledge and Practices in Trauma Care
Appendix C: MilitaryCivilian Exchange of Knowledge and Practices in Trauma Care
Pages 437-448
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From page 437... ...
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.1 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.
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From page 438... ...
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)
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From page 439... ...
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)
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From page 440... ...
Undergraduate •• Potential for exposure to national •• Students may attend any medical medical and international experts in multiple school regardless of the quality education -- fields •• Little to no exposure to military Health medical history Professions Scholarship •• Required military rotations are not Program (HPSP) required to have readiness relevance Undergraduate •• Exposure to civilian thought leaders •• No military medical curriculum nursing and potential mentors education Military medic •• Heavy emphasis on prehospital •• Disconnect between scope of practice education and trauma stabilization during deployment and in garrison training •• Little exposure to civilians in comparable positions •• No requirement for patient contact prior to deployment Residency/ •• Exposure to staff with deployment •• No opportunity to deploy even for fellowship -- experience an elective rotation (some residents military •• Education in readiness-relevant have completed Landstuhl Regional topics and Joint Trauma System (JTS)
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From page 441... ...
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)
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From page 442... ...
•• Diverse research opportunities •• Frequent civilian visiting professors •• Emergency War Surgery Course (EWSC) and ACS-endorsed courses taught frequently Military •• Immersion in high-volume, high- •• Cadre typically does not deploy physicians acuity trauma practice with civilian •• One site does not fully credential in practice -- experts cadre (Army Trauma Training Center civilian training •• Robust experience for multiple [ATTC]
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From page 443... ...
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 continued
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From page 444... ...
444 A NATIONAL TRAUMA CARE SYSTEM TABLE C-1 Continued STRENGTHS WEAKNESSES National Guard/ •• Immersed in civilian practice which •• Clinical practice experience can be Reserves generally affords a robust and variable and may not be combat diverse clinical experience relevant •• Immediate translation of lessons learned back to the civilian sector •• Deployment experience valuable for civilian disaster response Predeployment •• High-quality educational offerings at •• Students are expected to be experts training -- civilian all five sites in trauma care at the end of 2–4 training sites •• Deployment-experienced cadre weeks •• Very few deploying teams and physicians pass through any of these sites despite in-place requirements ACS sponsored •• Many with readiness relevance •• Some are prohibitively expensive courses •• Military members have contributed •• Combat-relevant modules needed in modules some courses Pre-deployment •• Most frequently taken predeployment •• Challenging to maintain standardized training -- EWSC course material with multiple sites offering •• Compact, high-yield course and little administrative support •• Includes ACS-endorsed course •• Students are expected to be experts in material trauma care at the end of 3 days •• Operational modules add relevance •• Little to no civilian input aside from ACS-endorsed content •• Nurse education track in parallel Senior Visiting •• 192 trauma and vascular surgeons •• Only selected trauma surgeons able Surgeon spent 2–4 weeks providing expert to participate Program consultation and clinical coverage at •• No clear plan or directive for LRMC or downrange continuing this program •• Many gave expert grand rounds lectures •• Research mentorship for military surgeons Professional •• Many have provided robust military •• Attendance has been curtailed by societies and support military regulations conferences -- •• Some have military committees •• Few have dedicated military sessions civilian •• New ACS–Military Health System (MHS) partnership promising for sustained military–civilian exchange
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From page 445... ...
•• 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 continued
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From page 446... ...
research budgets JTS CPGs •• Repository of most current best •• Some relevant topics not covered practices in military trauma care •• CPG development does not adhere to •• Housed and updated by the JTS systematic review standards •• Little to no external validation or civilian review/input Recently •• Wealth of knowledge and experience •• No mechanism for formally separated or •• Many go on to serve as civilians in interfacing with military personnel retired military MTFs or U.S. Department of Veterans who are facing deployment physicians, Affairs Medical Centers (VAMCs)
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From page 447... ...
APPENDIX C 447 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
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From page 448... ...
2010. Comparison of abdominal damage control surgery in combat versus civilian trauma.
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