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 D: Military and Civilian Trauma Care in the Context of a Continuously Learning Health System
Appendix D: Military and Civilian Trauma Care in the Context of a Continuously Learning Health System
Pages 449-458
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From page 449... ...
Table D-1 denotes to what degree these characteristics have been integrated into current trauma care systems, with specific comparison of the military versus civilian systems. Although pockets of excellence can be identified, 1 The analysis in this appendix was excerpted from a report 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 Elliott R
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From page 450... ...
Science and Informatics Digital capture Real-time access of the care to knowledge experience MILITARY CIVILIAN MIL CIV MIL CIV Prehospital Role 1, nonmedic Layperson first responder, 2BCD 3CD 3BCD 3BCD medic En Route 1 PH-Hosp, CASEVAC, First responder EMT, 2BCD 2CD 3BCD 1D MEDEVAC, medic paramedic Hospital Role 2, FST, small Lower level, (Initial) 2BD 2BCD 3BCD 2BD nontrauma center En Route 2 Hosp-Hosp, N/A Intratheater (medic 2BD N/A 3BCD N/A and nurse)
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From page 451... ...
APPENDIX D 451 Patient– Clinician Partnerships Incentives Continuous Learning Culture Engaged, Leadership empowered Incentives aligned instilled culture of Supportive system patients for value Full transparency learning competencies MIL CIV MIL CIV MIL CIV MIL CIV MIL CIV 3BD 3D 2CD 3D 3BCD 3CD 2BCD 3BCD 3BCD 2BD 3BCD 2D 2CD 1D 3BCD 2CD 2BCD 2BCD 3BCD 2BD 3CD 2D 2CD 2BD 3BCD 1BD 2BCD 2BCD 3BCD 2BD 2BD NA 2CD NA 3BCD NA 2BCD NA 3BCD NA 1CD NA 1D NA 3BCD NA 2BD NA 2BCD NA 1CD 2D 1D 1D 3BCD 2BD 2BD 2BCD 2BCD 2BD 1CD 2D 1D 1D 3BCD 2BD 2BD 1CD 2BCD 2D 2CD 2D 3CD 2CD 3BCD 2CD 3BCD 2BCD 3BCD 2BD AE = aeromedical evacuation; CASEVAC = casualty evacuation; CCATT = critical care air transport team; CIV = civilian; EMT = emergency medical technician; FST = forward surgical team; ICU = intensive care unit; MEDEVAC = medical evacuation; MIL = military; N/A = not applicable; VA = U.S. Department of Veterans Affairs.
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From page 452... ...
Similarly, the nearly ubiquitous use of the National Trauma Data Standard in acute care hospital-based trauma registries and adoption of Trauma Quality Improvement Program performance measures and monitoring greatly enhance standardization of care decisions and benchmarking of performance metrics. However, the interoperability of these products with other phases of care and health care exchanges remains limited.
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From page 453... ...
Although active mission details and information on trauma training programs and personal protective equipment must be safeguarded so as not to provide enemy forces with friendly force vulnerabilities, these data can still be analyzed and published on classified systems in near real time for performance improvement and to inform leaders. Additionally, when some unclassified data are being aggregated, these data can become classified and should then be transferred to classified systems.
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From page 454... ...
To some degree, the military has been effective in overcoming this barrier by establishing and maintaining a Joint Trauma System weekly worldwide trauma teleconference that connects the entire continuum of the trauma system in order to critically review trauma care delivery for best practices as well as for performance improvement opportunities. The most critical and ubiquitous barrier to a learning health system
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From page 455... ...
In the military, leaders are often comfortable promoting good news stories such as "highest combat casualty survival rate in history"; however, these same leaders are often reluctant to take it to the next level and be relentlessly dissatisfied with any degree of preventable morbidity and mortality. Additionally, as medical leaders do not own prehospital assets, and as nonmedical leaders who own prehospital assets are not held accountable for medical efforts, there is no true ownership of prehospital preventable morbidity and mortality, which is where most combat deaths occur (Butler et al., 2015; Eastridge et al., 2012; Kotwal et al., 2013; Mabry, 2015)
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From page 456... ...
Arriving at an FST in a combat zone versus a small rural nontrauma hospital may prove advantageous for a casualty if the FST has been seeing patients routinely; however, this may not be the case if it has been a while since the FST has seen and treated a casualty. While Table D-1 illustrates barriers with respect to characteristics of a continuously learning health system for both the military and civilian trauma systems, Box D-1 highlights specific military trauma system gaps or barriers in data collection, distribution, and use whose resolution could improve trauma care and patient outcomes.
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From page 457... ...
• "Responsibility for battlefield care delivery is distributed to the point where seem ingly no one ‘owns' it. Unity of command is not established and thus no single s enior military medical leader, directorate, division or command is uniquely focused on battlefield care, the quintessential mission of military medicine" (Mabry, 2015)
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From page 458... ...
: Implications for the future of combat casualty care. Journal of Trauma and Acute Care Surgery 73(6 Suppl.
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