Archive for November, 2010

Another Trauma Center Joins Research Consortium

Saturday, November 27th, 2010

The Major Extremity Trauma Research Consortium just gained another participating hospital–Cleveland’s MetroHealth Medical Center. The hospital is the only facility in Ohio that is part of this $38.6 million effort to conduct multi-center studies on the treatment and outcomes of major orthopedic injuries sustained on the battlefield. Discoveries will be applicable in civilian settings as well.

ACEP Survey Finds 60 Percent of US Hospitals Without Adequate Trauma Coverage

Wednesday, November 24th, 2010

More than 75 percent of the E.R. directors who responded to a recent American College of Emergency Physicians survey reported emergency departments that had inadequate coverage for plastic surgery, hand surgery and neurosurgery. What’s more, one-fourth reported an increase in patients leaving the emergency department before being seen by a specialist, which often leads to worse outcomes and increased need for further hospitalization.

“Without adequate on-call surgical coverage, our health care system cannot provide for emergency and trauma patients,” said lead study author Mitesh Rao, MD, MHS, of the department of emergency medicine at Yale University in New Haven, Conn., and clinical scholar with the Robert Wood Johnson Foundation.

“Twenty-one percent of emergency department deaths and permanent injury can be linked to shortages in specialty physician care. Transferring patients significant distances to an available specialist is sometimes the only option, but it can create a dangerous delay in care,” he said.

Sandra Schneider, MD, FACEP, the president of the American College of Emergency Physicians, said the study’s results demonstrate a desperate need to upgrade that portion of the health care system.

Read more.

MIT Suggests Helmet Face Shield Could Reduce Risk of Concussion

Tuesday, November 23rd, 2010

In a study published yesterday in the Proceedings of the National Academy of Sciences, MIT engineering researchers reported that a new helmet design that includes a face shield would be able to deflect the force of an explosion away from the face and significantly reduce its impact.

Lead author Raul Radovitzsky worked with colleagues at the MIT Institute for Soldier Nanotechnologies and the Defense and Veterans Brain Injury Center to study the effects of a blast to a soldier’s helmet-encased head using sophisticated computer models.

Read more about the research.

Washington Post Story Highlights Why Hemorrhage Treatment is Chief Concern

Thursday, November 18th, 2010

Largely due to improved treatments for hemorrhage (or severe bleeding), injuries sustained by soldiers during the more recent years of the Iraq and Afghanistan wars were more extensive and severe, but no less likely to be fatal than injuries sustained at the start of the war, reported journalist David Brown in a November Washington Post story titled “US Military Medics Use Old and New Techniques to Save Wounded in Afghanistan.”

The conclusion is that treatment has definitely improved over the nine-year course of the war. Brown notes, “Almost none of the improvement is the consequence of new drugs or new devices. Most of it, ironically, involves old technology and old practices that fell out of favor in the past 50 to 100 years and have been rediscovered and improved. And nearly all of them involve blood.”

The military emphasis on hemorrhage control arose out of the 2003 U.S. military operation in Somali immortalized in the book “Black Hawk Down,” after which an analysis of the deaths showed that bleeding was the primary culprit–soldiers who might have survived their wounds died as a result of blood loss. NTI board member Dr. John Holcomb was one of three military surgeons who treated the wounded from the battle, and who began to look for new ways to control hemorrhage, and specifically noncompressible hemmorhage (that occurring in the torso or neck, where direct pressure cannot be applied), after the Somali seige.

Innovations related to blood loss that have arisen in the last 15 years include the Combat Application Tourniquet, Combat Gauze, and the use of whole blood in transfusions. And the key to all of these improvements has been research—research conducted at both military institutions like the U.S. Institute of Surgical Research in San Antonio TX, and civilian research universities and trauma centers.

Of course, innovations discovered in war time make their way into civilian practice–but it’s important to point out that being in a state of war is the exception rather than the rule, and the opposite holds true most of the time: research conducted in randomized, controlled studies at civilian institutions provides robust results that lead to improved care both at home and on the battlefield.

For instance, the blood research done by the military in Balad following the Somali incident was a retrospective review of data. This was followed by a retrospective review of civilian transfusion practices and led to an ongoing prospective trial being conducted in the civilian setting because it can’t be done on the battlefield. And while Brown states the definitive answer to the Factor Viia challenge probably won’t be found because the prospective clinical trial can’t be done on the battlefield, there is a process to do it in the civilian setting. This is one of the most compelling reasons for military/civilian collaboration.

Further, far more civilians are affected by trauma than soldiers, underscoring the need for a substantial research effort that continues to make progress in the treatment of trauma–the number one killer of Americans between the ages of 1 and 44. Despite the advances in hemorrhage control over the past ten years, there is still much work to be done.

Network of Trauma Centers Studying Extremity Injuries Now Includes UTHSC-Houston

Friday, November 12th, 2010

Extremity injury is common in wartime, but it is also common among civilian victims of car crashes and other accidents. Thus, a network of 27 trauma centers across the United States, called the Major Extremity Trauma Research Consortium, is combining data and resources to study surgical practices and treatments on the civilian side in order to provide guidance to military medicine. With a $57 million Department of Defense grant, the network, which recently picked up the University of Texas Health Science Center in Houston, will look at the best techniques for building bones, preventing infection and affecting postive long-term rehabilitation outcomes.

A reporter on Houston Public Radio station KUHF – FM discusses the research and talks to Dr. John Holcomb, a trauma surgeon at UTHSC-Houston, 23-year Army veteran and NTI board member.

Newsweek Photo Essay Profiles Four Inspiring Servicemembers

Wednesday, November 10th, 2010

In a photo essay titled “The Road Home,” Newsweek features four warriors who suffered physical or psychological trauma in Iraq and Afghanistan yet pulled their lives back together to overcome these incredible challenges.

The profiles include Major David Rozelle who returned to service following an amputation; Carolyn Schapper, whose debilitating PTSD led her to fight for treatment for women soldiers; Andrew Coughlan, who is earning a college degree after his own struggles with PTSD following the devastation of his unit; and Dan Nevins, a reservist who fought to regain his former life after losing both his legs on a combat mission.

TBI and PTSD Continue to Confound

Monday, November 8th, 2010

A story, titled The Warrior’s Brain, published on Newsweek’s education site today explores the continuing mystery of traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) afflicting returning soldiers in ever larger numbers.

“The military reports that 144,453 service members have suffered battlefield concussions in the last decade,” the story reports, but experts believe concussions are vastly underreported. As TBI symptoms mimic those of PTSD and multiple other ailments, diagnosing and treating returning soldiers has become very problematic.

The article quotes Charles Hoge, former director of mental-health research at Walter Reed Army Medical Center, who concluded following a study of 2,700 returning servicemen that attributing postcombat symptoms to the effect of concussions could lead to a large number of military personnel receiving treatment for the wrong problem— “treatment that could actually make things worse for the patient and put undue strain on the health-care system.” Hoge spoke at NTI’s Annual Trauma Symposium this year on the same subject.

As the military continues to grapple with troops’ many medical issues, finding the right tools to disentangle TBI and PTSD and to treat both conditions will be a primary concern.

Ground-Level Falls Are Increasingly Deadly for the Elderly

Tuesday, November 2nd, 2010

In new research published in the Journal of Trauma: Injury, Infection and Critical Care, lead researcher Julius Cheng, MD, MPH, analyzed a large group of patients who suffered ground level falls from 2001 through 2005 and found that elderly patients are three times as likely to die following a ground-level fall compared to their under-70 counterparts.

Cheng’s team identified two major predictors of death in patients who have experienced ground-level falls: Age older than 70 years and a Glasgow Coma Scale (a widely used indicator of brain injury) score of less than 15. These specific factors may help emergency department staff better determine which patients have a higher risk of death and are more likely to require aggressive evaluation and treatment.

“Our research shows that falls from low levels shouldn’t be underestimated in terms of how bad they can be, especially in older patients,” said Cheng, associate professor in the Department of Surgery at the University of Rochester Medical Center. He suggested that as the population continues to age, trauma centers will have to be prepared for more of these types of injuries, which have a substantial impact on the health and independence of our older citizens.

Read the University of Rochester press release on the study.