Archive for the ‘Trauma Meetings’ Category

Trauma News Interview with Stewart and Winchell Captures Gist of Stakeholder Meeting on Zero Preventable Deaths

Tuesday, May 16th, 2017

Suggesting that the messaging surrounding the development of a national trauma system should shift from the traditional public health realm to the realm of national security, Dr. Ronald Stewart and Dr. Robert Winchell elaborated on the outcomes of the April meeting of stakeholders in the NASEM report on a National Trauma Care System published last year.

The broad consensus at the meeting, held in Bethesda, MD, was that “there needs to be a strong central directive, but the details need to be worked out locally,” said Winchell. Following establishment at a federal level, he said, “The actual nuts and bolts of the system would be developed by a broad coalition of the providers of the trauma community.”

Dr. Stewart also noted that trauma deaths occurring before the victim arrives at a hospital need to be explored if the goal of Zero Preventable Deaths after Injury is to be realized. “People recognize that if we’re going to get to zero preventable deaths, we have to know what those deaths are and when they occur. That would impact, for example, where you might put EMS resources or what you might do to improve access.”

Another gap in understanding is long-term outcomes for those suffering trauma. “We need to try to work towards data linkage to get more information on those prehospital deaths and also on long-term outcomes after somebody leaves the hospital or leaves a rehabilitation center,” explained Stewart.

“While you might argue that the NASEM report argues for some major revolutionary changes in how things are done, the practical implementation will in many ways be more evolutionary,” suggested Winchell. ”This effort is not necessarily creating entirely new systems, but leveraging existing initiatives and existing programs in a way that serves the end goal better.”

Attendees agreed that the call to action should be modified to ZPDD: Zero Preventable Deaths and Disability.

Read the article.

En Route Care and Training for Immediate Responders Explored in November JOT Supplement Covering 2015 MHSRS Proceedings

Thursday, November 10th, 2016

Supplement 1 of the Journal of Trauma, Volume 81, No.5, carries multiple papers emanating from the 2015 Military Health System Research Symposium. Below are synopses of several. To read the entire supplement, click here.

Machine learning and new vital signs monitoring in civilian en route care: A systematic review of the literature and future implications for the military  

Researchers Nehmiah Liu and Jose Salinas, PhD, reviewed the existing literature related to machine learning (ML) algorithms (MLA) and new vital signs monitoring (NVSM) in civilian en route care in order to determine their potential to fill combat medicine capability gaps. Recent machine learning technologies include those that monitor novel vital signs such as heart rate variability (HRV) and heart rate complexity (HRC). In addition, the photopletysmograph wave form and data quality indices offer potential ways to evaluate the need for lifesaving interventions during en route care.

There continues to be limited means of monitoring and recording data in-flight–such as vital signs, waveforms or interventions made by in-flight personnel—and an imperative to leverage such data to improve care and reduce mortality. Thus, the researchers are optimistic that new innovations could be of benefit in combat scenarios, but caution that further validation is warranted before widespread use. “Almost all studies required further validation in prospective and/or randomized controlled trials,” they determined.

 

Combat MEDEVAC: A comparison of care by provider type for en route trauma care in theater and 30-day patient outcomes

A 2009 change in military combat medicine policy led to the integration of Air Force Pararescuemen with paramedic training into MEDEVAC missions in a bid to decrease mortality. Paramedic level training was thus incorporated into the initial flight medic training of DUSTOFF medics in 2012, and a new program course at Fort Sam Houston provided additional paramedic and critical care training to promote all skill competencies at the EMT–intermediate/paramedic level as well as CCFP certification.

Vikhyat Bebarta, MD, and other researchers at Fort Sam Houston sought to analyze the resulting reallocation of resources in order to determine whether the intended benefit had been attained. In this study, the researchers identified and described medical providers and their specific roles on MEDEVAC missions, and identified associations between provider type, procedures performed, medications administered, survival, and 30-day outcomes.

In a review of more than 1,200 records of US casualties between 2011 and 2014, they determined that 76% of MEDEVAC personnel were medics, 21% paramedics, and 4% were advanced-level providers (ADVs) including nurses, physicians, and physician assistants. Providers with higher-level training were more likely to perform more advanced procedures during en route care; however, there was no significant association between provider type and in-theater or 30-day mortality rates. “More evidence is needed to determine the appropriate level of MEDEVAC personnel training and skill maintenance necessary to minimize combat mortality,” the researchers concluded.

Liu and Salinas argue for research that advances these technologies for en route care. “Importantly, these innovations could not only enhance trauma casualty care for our nation’s war fighters in a complex global environment but also close gaps–specifically, monitoring and the early detection and treatment of various injuries,” say the researchers.

 

Improving national preparedness for mass casualty events: A seamless system of evidence-based care

Researchers Alexander Eastman, MD, William Fabbri, MD, Kathryn Brinsfield, MD, and Lenworth Jacobs, MD, argue in a special report that the U.S. lacks “a unified, coordinated national system to respond to intentional mass casualty attacks….”

The researchers note that our national preparedness goal is thwarted by segmented, compartmentalized, or simply unobtainable investigative, clinical, and medical examiner data following mass casualty events. The distributed nature of the ownership of various segments of the civilian health care system is to blame, they say, and the consequence is that “conjecture, bias, and anecdote inform the civilian section of our national response rather than scientific evidence.”

The Hartford Consensus, they contend, is one attempt to evaluate evidence-based approaches to the problem. The authors review recommendations from successive Hartford Consensus meetings and conclude that immediate responders to mass casualty events, employing bleeding control techniques, hold the key to national resilience. Immediate responders, as defined, include law enforcement officers, bystanders, and even victims.

“Our military colleagues have demonstrated that a robust data collection system, organized scientific study of the problem, and system-wide implementation of evidence-based solutions can significantly improve survival from intentional traumatic injury,” Eastman et al. conclude. “Our duty now is to build the foundations of an analogous civilian system in order to begin to answer the remaining questions and to truly improve our national preparedness.”

NTI Meets and Greets at EAST 28th Annual Scientific Assembly

Friday, January 16th, 2015

The National Trauma Institute met with members of the Eastern Association for the Surgery of Trauma (EAST) during its annual meeting in Orlando Florida this week. The young surgeons and investigators attending the meeting benefited from scientific presentations, career-building and leadership sessions, and networking opportunities with colleagues and mentors from across the United States.

NTI provided information about its mission, recently published research and upcoming advocacy activities in Washington, DC.

Conference Brings Civilian and Military Medicine Closer

Monday, June 6th, 2011

With 400,000 U.S. military veterans calling Central Florida home, the city of Orlando hosted the Medical Technology, Training and Treatment (MT3) Conference, a forum to bring military and civilian medicine together for the benefit of both communities. The keynote speaker, singer Theresa Sareo, lost a leg when a drunk driver ran her over. Sareo now walks using a sophisticated prosthetic leg whose development is credited to advancements made as a result of military needs.

About 150 military medical personnel, medical device manufacturers and civilians in medical academia attended the conference, the fourth annual such event. Read coverage in the Orlando Sentinel.

NTI Joins TATRC to Discuss National Trauma Research Strategy

Thursday, March 31st, 2011

An article published today in dcmilitary.com, an electronic military publication, reports on a recent meeting convened by TATRC (U.S. Army Medical Research and Materiel Command’s Telemedicine and Advanced Technology Research Center) to put together a coaltion of federal and military agencies and civilian institutions to tackle the trauma research problem.

The National Trauma Institute was at the table along with members of the Combat Casualty Care Research Area Directorate and the U.S. Army Institute of Surgical Research to discuss ways to work together to bring more cohesion to the national research agenda. The meeting represented a first step. TATRC Deputy Director Col. Ron Poropatich said, “We are all ready to take it to the next level to meet the challenges and opportunities of today and the future.“

Advanced Airway Workshop to be Offered at Symposium

Monday, June 7th, 2010

The Advanced Airway Workshop is a three-hour course that will include live demonstrations on manikins and other adjunct materials. Offered as part of the National Trauma Institute’s 16th Annual Trauma Symposium, the workshop will be conducted by Drs Steven Venticinque and Antonio Hernandez—board certified anesthesiologists with board certification in critical care medicine

Workshop participants will rotate through 13 learning stations where they can utilize various fiber optic intubating devices, practice surgical airway approaches and use video laryngoscopes and supraglottic airway devices, among others.

The Advanced Airway Workshop costs $50 in addition to Symposium registration. Space is limited to 150 participants. To learn more about the workshop, click here.

Trauma Doctors Point to Innovations Arising from War

Monday, June 7th, 2010

At the Trauma and Critical Care Conference held in Austin on Friday, Texas trauma surgeons Carlos Brown and John Holcomb discussed clinical practices making their way into civilian emergency departments via battlefield trials. The conference was covered on KXAN, and you can see the story on the KXAN website.

Dr. Brown, trauma medical director at University Medical Center Brackenridge in Austin, talked about how tourniquet usage in the wars in Iraq and Afghanistan has led to a new, very effective tourniquet now being introduced in pre-hospital settings. Dr. Holcomb, with the University of Texas Health Science Center in Houston and an NTI board member, discussed an updated blood transfusion procedure. Surgeons in military trauma hospitals have discovered that bleeding stops more quickly when platelets and plasma are added to blood cells during a transfusion.

The conference was hosted by the Seton Family of Hospitals.

Registration for the Annual Trauma Symposium Now Open

Friday, March 5th, 2010

Today the National Trauma Institute opened registration for its 16th Annual Trauma Symposium, slated for August 30 – September 1, 2010 in San Antonio, Texas. The symposium is unique among medical conferences, as it is a blend of military and civilian speakers and multidisciplinary topics appropriate for the entire trauma team.

This year’s opening session is on provider resiliency and post-traumatic stress disorder. The program includes more than 80 research-based lectures covering advances in everything from trauma nursing to craniofacial surgery, plenary sessions on traumatic brain injury and resuscitation, and an advanced airway course.

To receive the early bird discount, register before July 1, 2010 on the NTI Website.

NTI Sponsors ACS COT Paper Competition

Sunday, October 11th, 2009

Along with the College of Surgeons, the Eastern and Western States COT, Region 7 COTs, and Wyeth Pharmaceuticals, the National Trauma Institute is funding the 2010 Resident Trauma Papers Competition. The competition will be held during the Committee on Trauma’s annual meeting March 10-12 in Las Vegas.

As just one of many ways that NTI supports trauma research, the competition rewards the best original research in the area of trauma care or prevention. Regional competition winners will present their papers during the Scientific Session of the annual meeting, during which national winners will be announced. Those papers winning national recognition are eligible for publication in the Journal of the American College of Surgeons.

For more information on the competition including submission deadlines, general surgery residents, surgical specialty residents and trauma fellows should visit the ACS website at: www.facs.org/trauma/traumapapers.html.

NTI Annual Symposium Report: Infection, Sepsis, and Combat Casualty

Tuesday, September 1st, 2009

LTC Clinton Murray, MD, Infectious Disease Fellowship Program Director at Brooke Army Medical Center in San Antonio, talked about the continuing challenge of fighting infections in combat casualty patients. Murray noted that in some types of combat injuries, infection rates can be 50 percent or higher, and he also noted that in the last four to five months, BAMC has seen more and more Afghanistan combatants with infection issues.

Murray discussed the significant role of nosocomial transmission in the spread of pathogens. He looked at several studies in France and with military hospitals showing the inter-hospital transmission of drug-resistant bacteria, and also noted that Canadian soldiers returning from Afghanistan are treated in civilian hospitals.

The impact of these pathogens includes more hospital days, more ICU days, more ventilator days, and more fatalities. Some of the pathogens, like acinetobacter, are more indicators of infection severity than cause of death; as Murray noted, “Patients will die with acinetobacter, rather than die of it.”

Yet for older and immunosuppressed patients, the presence of drug-resistant bacteria can place them at higher risk. Murray noted throughout the presentation that MRSA is a continual challenge that medical personnel have to wrestle with all the time. He encouraged the use of existing national and international infection control guidelines to help prevent the spread of pathogens, and discussed at least one case in which simple, common-sense measures have dramatically affected infection rates in ventilator patients.