Archive for the ‘Uncategorized’ Category

CDC Reports on Higher Death Rates in Non-Metro Areas

Tuesday, January 17th, 2017

The January 13th edition of the CDC’s Morbidity and Mortality Weekly Report (MMWR) provides an assessment of the leading causes of death in non-metro and metro areas between 1999 and 2014, concluding that higher rates of death occur in non-metro areas of the U.S.

After calculating age-adjusted death rates and potentially excess death in metro and non-metro areas for the five leading causes of death–heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke–the CDC concluded that more than half of all deaths (57.5%) from unintentional injury, specifically, that occur outside metro areas were potentially excess (potentially preventable). In metro areas, that rate is 39.2%.

The report suggests the higher rate of excess death in more rural areas of the country may be related to a variety of factors including less access to health care services, further distance to trauma care centers, and reduced EMS services as well as behavioral factors like physical inactivity during leisure and lower use of seat belts.

“Routine tracking of potentially excess deaths in nonmetropolitan areas might help public health departments identify emerging health problems, monitor known problems, and focus interventions to reduce preventable deaths in these areas,” the report concludes.

New Jersey Trauma Surgeon Provides a Dose of Reality in Star-Ledger Op-Ed

Tuesday, September 20th, 2016

Dr. Terrence Curran, a trauma and critical care surgeon at Morristown Memorial Hospital, wrote an op-ed for the New Jersey Star-Ledger in support of introduced legislation to raise awareness about the dangers of distracted driving. He suggests that widespread public education campaigns are needed to change behaviors and lower the toll of traumatic injury on our highways.

“The word ‘accident’ is not part of the vocabulary because trauma is a very preventable disease,” Curran says. He shares some of the realities of traumatic injury that he sees on a daily basis–for those lucky enough to live–damaged bodies, agonizing months in rehabilitation, permanent disabilities and suffering.

“I applaud Assemblyman John Wisniewski (D-Middlesex), Nicholas Chiaravalloti (D-Hudson) and Patrick Diegnan (D-Middlesex) for introducing legislation to raise awareness about the dangers of distracted driving,” Curran says, “but we should not wait for that bill to pass to increase the fight against dangerous driving behaviors.”

“While both the National Institute of Health and the Congressionally Directed Medical Research Program of the Department of Defense fund trauma research, the level of spending does not equal the magnitude of the problem,” he adds.

Read the full op-ed.


Shock Military Supplement Features Article on National Trauma Research Repository

Thursday, September 1st, 2016

“The National Trauma Research Repository: Ushering in a new era of trauma research” was published in the 2016 Military Shock Supplement, available online now. The article presents the Coalition for National Trauma Research (CNTR) advocacy and research activities, with a focus on the National Trauma Research Repository (NTRR), now under construction with the support of a Department of Defense grant.

The NTRR is a data-sharing platform that will facilitate exchange of research and knowledge between civilian and military researchers, reduce redundancy and maximize research funding. “Data-sharing avoids duplication of multiple, separate databases and results in conservation of research funds, ultimately leading to availability of funds for other studies and more investigators,” the authors add.

A CNTR member, the National Trauma Institute is administering the grant and managing the development of the NTRR.

Jenkins Relays NTI Impact with DoD Funding for Sponsored Studies

Thursday, August 18th, 2016

At the Military Health System Research Symposium (MHSRS) this week, NTI Past-Chair Donald Jenkins, MD, provided an update on NTI’s research achievements made possible with funding provided through the Department of Defense.

Research funded through DoD grants has resulted in 16 peer-reviewed publications, with two in press; 16 national, two regional and six local presentations; and follow-on funding for two studies from the Joint Warfighter Medical Research Program.

Dr. Mitch Cohen’s study on the Timing and Mechanims of Traumatic Coagulopathy resulted in a 2013 JOT article “Characterization of platelet dysfunction after trauma.” Dr. Cohen’s article has been the most cited of NTI’s DoD-funded studies, to date receiving 77 citations.

Dr. Jenkins explained how these research findings are closing gaps in knowledge regarding best practices for military and civilian trauma care. Review the presentation.

Lagging American Lifespan Due to Traumatic Injury

Thursday, February 11th, 2016

An Associated Press article by Lindsey Tanner this week sheds light on a recent study of Centers for Disease Control and Prevention statistics on injury in America. The CDC data shows that injuries from violence, vehicle crashes and drug poisonings and overdoses are the leading cause of death for Americans up the the age of 44.

“U.S. death rates from these three injury categories exceed those in 12 other developed countries included in the study: Austria, Denmark, Finalnd, Germany, Italy, Japan, the Netherlands, Norway, Portugal, Spain, Sweden and the United Kingdom,” Tanner says.

The study was published this week in the Journal of the American Medical Association. The study’s lead author, Andrew Fenelon, a sociologist with the CDC’s National Center for Health Statistics, is quoted as saying, “If we brought mortality from car crashes, firearm injuries and drug poisonings down to levels that we see in these other countries, we’d gain about a year of life expectancy.”

Read more.

Researchers Develop Model to Predict Wound Healing Success

Tuesday, July 28th, 2015

A team of military and civilian researchers has developed a way to make predictions about wound healing that could help surgeons make critical decisions, such as when to close a wound. This information could minimize complications for traumatically injured patients, as both premature and late closing can lead to serious problems for the patient.

Using advanced computer analytics and looking for patterns of inflammation, the team from the USU Walter Reed Surgical Critical Care Initiative analyzed biomarker data in collected samples of blood and tissue, as well as clinical observations to predict the likelihood of wound failure.

“This study demonstrates that it is not merely the physical destructive nature related to the mechanism of injury in wounds, but the (body’s) resulting inflammatory response, that dictates wound outcome,” says the senior author, Navy Capt. (Dr.) Eric Elster, in a press release. Dr. Elster is professor and chair of the Department of Surgery at the Uniformed Services University of the Health Sciences and the Walter Reed National Military Medical Center. He is also a member of the Board of Directors of the National Trauma Institute.

Elster points out that the response is similar in both military and civilian patients, allowing for a translation between patient populations.

The study, ”Lessons of War: Turning Data into Decisions,” was published online July 17, 2015 in the journal E-Biomedicine.

Heroes of Military Medicine Honored at CP3 Banquet

Friday, May 8th, 2015

Dr. Peggy Knudson, NTI Board member and Medical Director for the Military Health System (MHS) Strategic-ACS Partnership, is flanked by Heroes of Military Medicine Bob Woodruff and Colonel Todd Rasmussen at a Center for Public Private Partnerships (CP3) awards banquet last night.

Colonel Rasmussen was one of three active duty military medical professionals to receive the Hero of Military Medicine Award, while Woodruff and his wife, Lee, received Hero of Military Medicine Ambassador Awards. Woodruff suffered a traumatic brain injury from a roadside bomb in Iraq in 2006, while reporting for ABC “World News Tonight.” After his recovery, he and his wife founded the Bob Woodruff Foundation in support of veterans and their families.

Each year, CP3 honors individuals who have distinguished themselves through excellent and selfless dedication to advancing military medicine and enhancing the lives and health of the country’s wounded and ill service members, veterans and their families. Proceeds from the Heroes of Military Medicine dinner support the Veteran Metrics Initiative, which conducts translational metrics-related related research to determine what best improves the health and well-being of veterans.

Thousands Die While Funding Lags: An Interview with COL Brian Eastridge

Wednesday, April 22nd, 2015

COL Brian Eastridge

More than 1,100 of our service men and women killed on battlefields in the Middle East might be alive today if military medics and surgeons had better tools to mitigate hemorrhage and optimize airway management or if transport to a field hospital had been more expeditious.

Between October 2001 and June 2011, 4,596 American soldiers died on the battlefields in the Iraq and Afghanistan conflicts. Dr. Brian Eastridge wanted to know how many of them could have survived if the right training or equipment were available.

Eastridge is Professor of Surgery in the Division of Trauma and Emergency Surgery at the University of Texas Health Science Center at San Antonio and a colonel in the US Army with 27 years of service and six operational deployments. During his active duty service, he was the Trauma Consultant to the U.S. Army Surgeon General and co-developer and Director of the Joint Trauma System. His analysis, published in the Journal of Trauma and Acute Care Surgery in 2012 (Vol 73, Number 6, Supplement 5), determined that 25% of those casualties had injuries that were potentially survivable.

Why weren’t the training and equipment available to save these soldiers?

“There are simply some huge gaps in our knowledge,” Dr. Eastridge said. “And those gaps are directly related to a paucity of funding to do the research. Research is desperately needed to narrow those gaps and improve care and survival of our combat wounded.”

Extrapolating Dr. Eastridge’s findings to the home front, where more than 190,000 Americans died from traumatic injury in 2014, that would mean 47,500 deaths could have been prevented—deaths that occurred on the nation’s roadways, in private homes and in remote areas of the country.

While that analysis has never been done, Dr. Eastridge noted that the percentage of survivors would likely be far greater.

“The most common mechanism of injury and death on the battlefield was explosion, which imparts a tremendous amount of destructive energy to the body and leads to instantaneously lethal injury,” he said. “This mechanism occurs infrequently in the civilian environment. Since fewer patients are subjected to this amount of injurious energy, intuitively, it is likely that a larger percentage of our trauma patient mortality here at home have potentially survivable injury.”

What is needed to close the gaps in knowledge and to start saving more lives, both on the battlefield and at home, is an investment in traumatic injury research that is commensurate with the toll of trauma on society.

Research Translation Works Both Ways

As with the wars of antiquity, these recent conflicts have afforded the development of new knowledge and, likewise, new perceptions of the gaps that remain. Military surgeons have had the unique opportunity to learn from exposure to large numbers of high acuity injuries, an experience that is unmatched in civilian emergency departments and trauma centers.

As Dr. Eastridge explained, if a problem can be identified, it can be studied and a mitigation strategy developed. For instance, early in the Iraq war, surgeons were seeing a lot of death from isolated extremity injury, which they believed to be preventable with the use of a time-tested tool—the tourniquet.

Tourniquets had been around for thousands of years, but had fallen out of favor due to concerns about losing limbs as a result of prolonged ischemia. But Tom Walters, a PhD investigator at the US Army’s Institute for Surgical Research (ISR), took the problem to the research laboratory, and within less than a year, he had an answer. Walters tested all of the commercially available tourniquets on healthy volunteers to judge their ability to stop hemorrhage, to be tolerated by the patient and to be realistically deployed in a combat environment. His work led to the fielding of the Combat Application Tourniquet (CAT), now standard issue for every soldier deploying to the battlefield.

As the CAT made its way into the field in late 2005, attributable death from extremity injury began to fall from 23.3 deaths per year; to 17.5 by 2007, and to 3.5 after full implementation of the device, representing an 85% decrease in mortality. With the translation of military medical advances into the civilian establishment, first responders in the U.S. are now beginning to carry these life-saving devices, illustrating that research in trauma is bidirectional.

Now, the lessons we have learned on the battlefield and translated into civilian practice need to be refined through the controlled scientific studies that are the purview of the civilian medical system, using large datasets and clinical networks. In this way, the civilian injury research and care template can be utilized to subsequently advance injury care on the next battlefield. Our US military troops deserve no less.

Dr. Eastridge was instrumental in translating his work with the trauma system in Southwest Texas to the development of a formal military trauma system for the battlefield of Afghanistan and Iraq. The model of the Southwest Texas Regional Advisory Council was particularly fitting to the battlefield environment, which resembled the rural and sparsely populated 26,000-square-mile Texas region, which has few medical facilities available to manage the injured patient. Timing of evacuation and transport proved to be remarkably similar between the South Texas region and the Middle East battlefield.

Having recently returned from his sixth deployment, Dr. Eastridge is seeking to enhance the military trauma system model and validate the concepts of tactical pre-hospital care on the battlefield. His current work is conducted though the DoD-funded Remote Trauma Outcomes Research Network, attempting to narrow some of the pertinent knowledge gaps brought to light during the war.

Pre-Hospital Research May Yield Best Results

“Our most important efforts will be to better understand and mitigate the suffering and loss of life that occurs on the streets and on the battlefield before a casualty can reach the hospital…I think that’s where we will get our biggest ‘bang for the research buck,’” suggested Dr. Eastridge. “Many potentially survivable injuries in remote areas become non-survivable only because of the time it takes to get to a properly equipped hospital.”

To this end, improved devices to monitor physiology and assist in the triage of patients, means to arrest torso and junction hemorrhage, and treatments to increase the window of survivability between the injury and the hospital are future targets for trauma research.

For both the Department of Defense and civilian trauma centers, the fact remains that the current level of research funding does not come close to matching the need. “The lack of money is a ubiquitous issue in research. We literally have hundreds of ideas to pursue and gaps to close,” said Dr. Eastridge. “If we had the resources, I can only imagine the progress we could make and the number of lives we could potentially save.”

Defense Health Agency Chief Addresses Need for National Trauma Clinical Research Program

Tuesday, April 14th, 2015

Today Lieutenant General Dr. Douglas J. Robb, Director of the Defense Health Agency, testified about the financial needs of his agency in a Congressional Budget hearing.

When U.S. Rep. Dutch Ruppersberger specifically asked him about the proposed National Trauma Clinical Research Program (which NTI has advocated for, along with the Coalition for National Trauma Research), LTG Robb noted the importance of civilian-military collaboration in research and reminded him that the rapid advances in survivability since the start of the wars in the Middle East have been due to such things as improvements in the Joint Trauma System, which can be credited to civilian models and research.

Dr. Robb encouraged the Committee to be supportive and warned that sequestration would be extremely detrimental to this and other Defense Health Programs that aim to improve the continuum of care for active service people and veterans.

Watch the entire hearing HERE.

On Anniversary of Lincoln’s Death: Modern Analysis of his Traumatic Injury

Monday, April 13th, 2015

An article examining the gunshot wound to the head that killed Abraham Lincoln asks whether the 16th president could have survived had the injury occurred today. On the 150th anniversary of Lincoln’s death (April 15), journalist Will Hadden confers with Vanderbilt Hospital neurosurgeon Dr. Allen Sills to find out how far trauma care has come since 1865.

Despite the advent of CAT scans, metabolic suppression, advanced airway management techniques and new surgical interventions, Sills determined, Lincoln’s penetrating brain injury would have almost certainly still resulted in death. Had he survived, his severe brain injury would cause disabilities preventing him from carrying out his presidential duties.

Read the article.