Dr. Alan Peterson, director of the STRONG STAR Multidisciplinary PTSD Research Consortium, kicked off the opening plenary session of the Annual Trauma Symposium with an overview of the signature injuries of the current conflicts in the Middle East. Post-Traumatic Stress Disorder and Traumatic Brain injury are two of them.

Dr. Peterson mentioned that data collection related to PTSD has stepped up significantly in the last several years within the military, so much more information is available than it has ever been before. Peterson’s focus is on the medics–those who take care of the traumatically injured in combat.

In August 2004, Peterson and others set up an Air Force Theater Hospital in Iraq and began a study to collect data on military medics. His goal was to identify factors that contribute to risk and resilience in deployed military medical personnel.

He looked at trauma factors (severity, frequency, type), individual factors, and environmental factors.
Medics are exposed to wounded and deceased American soldiers, attacks from rocket and mortar fire, uncooperative Iraqi patients, long work hours with little sleep, removal from social support systems, and more.

Among the general population, he pointed out, about 61% of all American men are exposed to a significant traumatic event, and about 8% of that population develops PTSD. More women actually develop PTSD than men, in spite of the fact that fewer women are exposed to traumatic events. While only a small percentage of Americans are exposed to combat, the risk of PTSD is extremely high for this group, as it is for those exposed to rape. Whether the trauma involves a life threat and physical injury is also an indicator of PTSD risk.

The study identified the most stressful events in the lives of deployed medics. Those who witnessed arm amputation, leg amputation, severe pain, head and eye injuries, facial injuries and severe burns, injured women and children and exposure to dead bodies, among other traumas, reported the most stress. There is a significant relationship between those who experienced healthcare trauma and those who developed PTSD.

Protective factors that contribute to resilience include friends’ and family members’ support and respect for the officers in one’s command. Good unit cohesion is also a significant buffer to stress. Peterson noted that one’s attitudes and beliefs about the mission and training are also significant factors related to resilience. If a medic feels his or her training prepared him or her well and truly believes in the mission, there is a greater level of resilience.

Providing healthcare in an environment in which the patients are not cooperative or may even be hostile was also identified as a significant stressor, as is the case with the Iraqi patients military medics are required to treat. “When you’ve used your blood supply to take care of Iraqi insurgents and then injured Marines come in and die because there’s no blood left, that is really difficult,” mentioned Peterson.

Peterson next discussed medical resiliency training currently in use. The Army MEDCOM program, for instance, focuses on managing health, problem solving, increasing strengths and positive responses. His suggestion is that the best training should just be rigorous military training–the better people are trained overall, the better they will fare in deployed situations. And because of the importance of unit cohesion to resilience, professional military education and leadership training is paramount. The better the leaders, the more protected individuals in the unit are.

Today, the National Trauma Institute would like to recognize the sacrifices made by American troops in Iraq and Afghanistan and around the world–those who have given their lives and those permanently scarred, as well as their families who have suffered tremendous loss.

We pledge to work tirelessly to support trauma doctors in their efforts to reduce fatalities and disabilities related to war-time trauma. To join NTI’s efforts, please consider contributing to our Stop the Bleeding campaign–an effort to fund research related to hemorrhage, which is responsible for the majority of preventable deaths of our soldiers in the current conflicts.

New research from the University of Pennsylvania School of Medicine, presented at the EAST meeting this weekend, shows that trauma victims who sustain their injuries at night or on the weekend are not susceptible to the same medical care disparities as those who suffer time-sensitive illnesses such as heart attacks and strokes. The reason is because the regionalized trauma system, which mandates that trauma victims be taken to 24-hour, fully staffed facilities (Level 1 trauma centers), insulates these people from the problems associated with lower and less specialized staffing at regular hospitals during off hours.

The study’s lead author, Dr. Brendan G. Carr, says, “We found that no matter when you are injured, you get the same type of care when you are brought to a trauma center.”

Carr believes that the study has implications beyond trauma care. “The…emergency care system as a whole can be redesigned to take better care of the sickest, most vulnerable patients,” he says.

Read the University of Pennsylvania School of Medicine press release on the study.

A retrospective study published in the most recent issue of the Journal of Trauma looks at how immobilization of trauma victims at the scene relates to their rates of survival. The researchers determined that the risk of dying was two times higher for those who had been immobilized.

Dr. Elliot R. Haut, the lead researcher and an assistant professor of surgery at Johns Hopkins University School of Medicine, believes that EMS protocols should be re-examined and revised based on this new information. Immobilization should not be automatically applied to every trauma patient, since the procedure can take up precious time and delay transport to a hospital, Haut argues.

Read the Baltimore Sun article about the study and its potential implications for trauma protocols in the state of Maryland.

Last week, a news release from the Millennium Research Group (MRG) caught our eye. Despite an economy that continues to struggle and a sluggish forecast for many industries, MRG projects rapid growth over the next five years for the trauma fixation devices market.

MRG’s analysts expect that shifts in device innovation and anatomical focus will allow some smaller companies to expand and move into the market, fueling competition and more growth.

While this is good news for the economy, it’s even better news for trauma victims, and we applaud the companies that are rapidly working to improve treatments with specialized and advanced fixation technologies. MRG mentions low-profile plating systems as an example of a technology quickly becoming popular. Such systems help ease treatment of trauma to extremities “where soft tissue coverage is minimal and thicker systems often cause irritation.”

For more information about emerging trends in trauma treatments, read MRG’s new report, US Markets for Trauma Devices 2010 or visit its website.

Retired Army Sgt. Richard Yarosh will be the first Iraq war veteran to be immortalized at the National Portrait Gallery in Washington D.C., a fitting tribute to a man who gave everything but his life for his country. His life-size image will join those of other great Americans at the gallery in November. Yarosh was badly burned when his vehicle struck an explosive device while he was on patrol in Iraq.

Yarosh represents thousands of veterans who continue to return from war horribly disfigured due to burns. Unfortunately, burn treatments have a long way to go before there is any hope of burn victims reclaiming their lives and former countenances. This is why NTI made burn treatment one of its priority research areas–there is so much to do and so many people to help.

Development of skin replacements would reduce scarring and scar contraction to promote better rehabilitation. Other promising properties of new skin include stronger and more flexible wound covering, the ability to re-grow hair follicles and the presence of sweat glands, which promotes better body temperature control.

Much research needs to be done before new skin is a reality–we are doing all that we can to get such research funded so that it bears fruit in time to benefit our returning service people.