By American College of Surgeons, Special for USDR
Trauma leaders and experts gathered at the 2016 Clinical Congress of the American College of Surgeons (ACS) this week to formally announce their commitment to working together with partners to achieve zero preventable military and civilian deaths from trauma. That goal, established in a June 2016 report by the National Academies of Science, Engineering and Medicine (NASEM), would save an estimated 30,000 lives per year once achieved.
The NASEM report, “A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths,” calls on military, government, and health care leaders to join together to establish a coordinated national trauma system. The report outlines 11 specific recommendations that would help the nation realize the vision that “the first casualties of the next war would experience better outcomes than the casualties of the last war, and all Americans would benefit from the hard-won lessons learned on the battlefield.”
The battlefield has long been a source of innovation in trauma care, and the percent of fatalities among all wounded service members has dropped significantly in recent decades – from 23 percent during the Vietnam War to 9.3 percent in Afghanistan and Iraq, according to the report. Despite better outcomes, the report cites gaps in care that have cost lives and “serious limitations in the thoroughness of the diffusion of those gains over time and space, and both within the military and between military and civilian sectors.”
ACS has focused on efforts to improve care for injured patients since it formed the Committee on Trauma (COT) in 1922 (then known as the Committee on Fractures). Today, the Committee on Trauma, which is administered by an 85-member leadership team and 3,500 regional surgeon leaders, oversees a spectrum of initiatives aimed at advancing the standard of trauma care for practitioners, trauma centers, and trauma systems. These initiatives include Levels I-IV trauma center verification, the nation’s only risk-adjusted outcomes-based trauma quality program, and trauma courses taken by more than 1 million medical professionals globally.
“The ACS Committee on Trauma has a long history of leading efforts to improve care for injured patients, and we plan to be a willing, able and active partner in achieving the goal of zero preventable deaths from injury – on the battlefield and across the nation,” saidRonald M. Stewart, MD, FACS, Chair, ACS Committee on Trauma (ACS COT).
During a panel session held Monday, surgeons highlighted the rationale for this effort. “Currently, few systems are in place to transfer best practices and innovations between military and civilian trauma systems,” said Col. Jeffrey A. Bailey, MD, FACS, Walter Reed National Military Medical Center.
M. Margaret (Peggy) Knudson, MD, FACS, Medical Director of the Military Health System Strategic Partnership American College of Surgeons (MHSSPACS) added, “Surgeons who return home to practice at military hospitals may see far fewer trauma patients and, as a result, may not have the skills and readiness to quickly return to the warfront should they be called to serve.”
The surgeons also outlined steps that can be taken to implement the report’s 11 recommendations. Leadership at the federal level, including support from the White House, stronger coordination between states, steps to address gaps in trauma care, and a national trauma research plan with dedicated funding for clinical trials, were among the priorities discussed.
“In order to drive new innovation we need to establish a stronger system of data sharing nationally, ensure all hospitals providing trauma care are collecting robust data, and coordinate a national research plan with dedicated support and funding for clinical trials,” said Eileen M. Bulger, MD, FACS, member of the executive committee of the ACS COT.
Death from Injury Continues to be a Public Health Crisis
NASEM first drew attention to accidental death and disability as a public health crisis 50 years ago. Its report on the issue released in 1966 was pivotal in driving early development of trauma systems across the United States. Yet 50 years later, the U.S. still does not have a coordinated national trauma system.
Trauma continues to be the leading cause of death in the U.S. for those ages 1-46 years old1, accounting for nearly half of all deaths in this age group and more loss of years of life than any other illness or disability. According to the report released in June, one-third of Americans do not live within one hour of a Level I trauma center, the highest level of trauma care for the severely injured.
“Americans believe that they are part of a coordinated trauma system, but the reality is, the care you receive is highly dependent on where you live,” said Robert J. Winchell, MD, FACS, Chair, ACS Trauma Systems Evaluation and Planning Committee. “State and regional governments prioritize trauma care differently and there are varying sources of coordination and funding. Despite the significant public health implications, trauma care hasn’t become a consistent priority in all states.”
Once patients arrive at a trauma center, compliance with available guidelines is highly variable from region to region, even though evidence shows patients who receive trauma care according to recommended best practices are 58 percent less likely to die than patients who do not2. About half of trauma deaths occur at the scene or in route to the hospital, yet pre-hospital care also is highly variable. In 19 states, no statewide protocols for emergency medical service (EMS) systems exist, and in another 14 states, EMS services can choose whether or not to use protocols. The result is an uneven makeshift framework of pre-hospital care.
“Over the past five decades we’ve seen the rate of death from injury drop dramatically as our trauma system has advanced. Those who have access to optimal trauma care have significantly greater chances of surviving injury than they would have had a generation ago,” said Dr. Stewart. “But because our patchwork of trauma systems has no national coordination, far too many people don’t have access to optimal care, leading to tens of thousands of unnecessary deaths each year.”
According to the report, up to one in five civilian trauma deaths and a quarter of military trauma deaths could be prevented if all injured patients receive appropriate care.
“Thousands of patients may needlessly lose their lives each year because of these gaps in care,” said Patrick M. Reilly, MD, FACS, member of the ACS COT executive committee. “When the knowledge, skills and protocols exist to save more lives, surviving trauma shouldn’t be a matter of chance or geography.”
ACS Committee on Trauma to Convene Leading Organizations to Support National Trauma System
In early 2017, the ACS COT along with partner organizations will hold an “Innovations in Trauma Care Conference” to convene national stakeholders in addressing the gaps highlighted by the NASEM report. ACS will also advocate for national support, leadership, and funding, as well as a coordinated national trauma research plan.
“We want to enable local regions to establish systems of care that address their unique needs, yet this needs to be done in a uniform way to ensure we address significant gaps,” said Donald H. Jenkins, MD FACS, member of the executive committee of the ACS Committee on Trauma.
The MHSSPACS, formed in 2014, is working to establish programs to translate military trauma innovations to civilian health care and better coordinate military and civilian trauma education and ongoing training and development. ACS is supporting the Mission Zero Act (S. 3407 and H.R. 6229) currently before Congress, which would provide $40 million in funding to the U.S. Department of Health and Human Services to facilitate partnerships between military trauma care teams/providers, and high-volume civilian Level I trauma facilities.
Editor’s note: The Position statement of the American College of Surgeons Committee on Trauma on the National Academies of Sciences, Engineering and Medicine report, A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths after Injury, appears online on the Journal of Trauma and Acute Care Surgery website ahead print publication on November 3.
1. Rhee, P., B. Joseph, V. Pandit, H. Aziz, G. Vercruysse, N. Kulvatunyou, and R. S. Friese. 2014. Increasing trauma deaths in the United States. Annals of Surgery 260(1):13-21.
2. Shafi, S., S. A. Barnes, N. Rayan, R. Kudyakov, M. Foreman, H. G. Cryer, H. B. Alam, W. Hoff, and J. Holcomb. 2014. Compliance with recommended care at trauma centers: Association with patient outcomes. Journal of the American College of Surgeons 219(2):189-198.
About the American College of Surgeons
The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 80,000 members and is the largest organization of surgeons in the world. For more information, visit www.facs.org.
SOURCE American College of Surgeons