Archive for November, 2016

Senator-Elect Duckworth Calls for Better Integrated Trauma Care

Wednesday, November 23rd, 2016

In a Time magazine opinion piece, Illinois senator-elect Tammy Duckworth and Boston Marathon bombing victim Patrick Downes state their case for establishing a military-civilian trauma care partnership that can save lives.

As a U.S. House member, Duckworth introduced the National Trauma Care System Act this legislative session, which would enact many of the recommendations published in the June 2016 NASEM report, A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury.

Duckworth was traumatically injured when a rocket-propelled grenade hit the Black Hawk helicopter she was piloting over Iraq in 2004, and has championed trauma care and research throughout her tenure in Congress. Her commentary in Time magazine draws well-deserved public attention to this life or death issue.

Read the article.

Trial of Body Cooling Procedure Concludes–One Step Closer to Saving Lives

Monday, November 21st, 2016

The November 28, 2016 edition of The New Yorker reports that Baltimore’s Shock Trauma recently completed a trial of emergency preservation and resuscitation (EPR), a procedure that may be able to save patients who otherwise would die from exsanguination. It’s a procedure wherein the chest cavity of a bleeding patient is pumped full of ice-cold saline. The procedure drops the patient’s brain temperature into the lower fifties and puts the body into a state of suspended animation for up to an hour while surgeons can repair bullet holes and other injuries.

EPR “has long been proved successful in animal experiments, but overcoming the institutional, logistical, and ethical obstacles to performing it on a human being has taken more than a decade,” reports Nicola Twilley, author of The New Yorker article. Dr. Sam Tisherman directed the EPR trial–he began work related to the procedure while at the University of Pittsburgh. Continuing the work of Dr. Peter Safar, his mentor and one of the founding fathers of resuscitation science, Dr. Tisherman has been joined in his pursuit by many colleagues across the United States throughout the years.

“In the United States, between thirty and forty thousand people a year bleed to death from fixable injuries,” says Twilley. “Ultimately, if the technique does evolve as Tisherman envisages, it will simply become the next step for treatment after CPR has failed, used to buy time and prevent brain death.”

It will likely be two years before the results from the trial can be made public.

Read the full, amazing story about how the research unfolded over three decades to make this procedure possible.

NASEM Releases Video Illustrating Need for a National Trauma Care System

Friday, November 18th, 2016

To accompany its June 2016 report calling for improved trauma care in the U.S., the National Academies of Science, Engineering and Medicine created a video that briefly illustrates the report’s main messages. Advances in military  trauma care achieved during the Afghanistan and Iraq wars can be translated to the civilian sector to improve trauma care for all Americans, say the report’s authors. Sustaining these military advances, and closing the gap between the military and civilian sectors, can help to improve trauma care—to protect those the nation sends into harm’s way, and to benefit every American.

View the video HERE.

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.”

New Book Celebrates the Progress of Trauma Care in America

Monday, November 7th, 2016

Dr. Catherine Musemeche is a student of medical history and a former pediatric surgeon who weaves vivid personal anecdotes throughout her comprehensive telling of the evolution of trauma care in America—from the Civil War through the conflicts in Iraq and Afghanistan.

Recently published by University Press of New England, HURT—The Inspiring, Untold Story of Trauma Care reads like an adventure story, complete with compelling prose and action-packed portraits of real-life heroes like R Adams Cowley, James Styner, Deke Farrington, Sue Baker, John Paul Stapp and plenty of others. HURT is both a celebration of how far the trauma care system has traveled in an astonishingly short amount of time and a reminder of what is left to accomplish.

A board-certified Fellow of the American College of Surgeons, Dr. Musemeche and has flown on rescue helicopters, trained and practiced in trauma centers in Houston and Chicago and operated on hundreds of trauma victims of all ages. Her work is meticulously cited and includes references to articles by Thomas Scalea, Martin Croce, David Livingston, Brent Eastman and many others with whom the trauma care community is very familiar.

This is a great book for ER residents, aspiring trauma surgeons, nurses or anyone in the medical field who is interested in knowing about the history of the U.S. trauma system and standards. Order a copy today, or catch Dr. Musemeche’s next book reading at BookWoman in Austin, TX on Saturday, November 26 at 1:00 p.m. Check the BookWoman calendar for updates.