By Patrick Gillich & David Browne
The National Academies of Science, Engineering and Medicine’s (NASEM) Landmark Report and Conference, A National Trauma System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury.
TRAUMA is struggling to differentiate itself as a national health issue despite its status as the leading cause of death for Americans under the age of 46 and the leading cause of years of potential life lost before the age of 75. The difficulty is that trauma doesn’t minimally define a discrete, potentially curable disease (e.g., including victims of mass shootings, terrorist incidents, auto collision, and geriatric falls). It is also struggling to find proportional research funds relative to its vast total burden on society versus, for example, conditions like HIV/AIDs, cancer, drug abuse and STDs, which receive funding that is greater than their societal burdens.
To respond to this problem there has been a five-year “total system-wide” effort (including all civilian and military stakeholders) to improve trauma care (primarily) and prevention (secondarily). As part of this national call to action, AAAM participated in the Achieving Zero Preventable Deaths Conference (April 2017) held at the National Institutes of Health (NIH) Natcher Conference Center in Bethesda, MD. This conference was sponsored by the American College of Surgeons Committee on Trauma (ACSOT), in partnership with the National Highway Traffic Safety Administration (NHTSA), the U.S. Department of Defense (DoD), and the National Institutes of Health (NIH) with the intention to “disseminate, refine, and implement the recommendations proposed by NASEM”.
The report presented and discussed in breakout sessions (to further improve upon current recommendations) documents that in spite of major advances in recent years in trauma care, the major parameters driving the variability in mortality outcome in the United States continues to be when or where you are injured. This trend in survivability data motivates the need to prioritize the construction of a National Trauma Center as well as the systematic transfer of the military system learnings from recent global conflicts with those from the civilian sector. An example of the total system perspective and military approach is the imperative that non-medically trained pre-first responders, laypeople who are bystanders of the trauma or the incident causing it, are capable of and enabled to engage in the very first step of the continuum of care, (i.e., performing the simple steps to keep the injured alive prior to the arrival of appropriate medical care).
The NASEM report presents a National Trauma Action Plan that enables zero preventable deaths after injury and minimal trauma-related disability for all Americans. This ambitious goal requires the support and commitment from a large and diverse group of a continuum of care participants including those of us who are members of AAAM and involved with AIS.
The plan proposed, documents a clear requirement for improving data collection, integration, quality, and sharing with regards to trauma and outcome data spanning the complete continuum of care. The action plan further focuses on education, trauma research funding, enhancing data collection/integration and advocacy at local, state and national levels to influence and create legislation.
Members of AAAM are encouraged to read the report in brief and all recommendations at: http://www.nationalacademies.org/hmd/Reports/2016/A-National-Trauma-Care-System-Integrating-Military-and-Civilian-Trauma-Systems.aspx, and watch the video at https://www.youtube.com/watch?v=nFGDdup4OFc&feature=youtu.be
Please bring your expertise to this noblest call to action.