A National Trauma Care System : Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury

Advances in trauma care have accelerated over the past decade, spurred by the significant burden of injury from the wars in Afghanistan and Iraq. Between 2005 and 2013, the case fatality rate for United States service members injured in Afghanistan decreased by nearly 50 percent, despite an increase in the severity of injury among U.S. troops during the same period of time. But as the war in Afghanistan ends, knowledge and advances in trauma care developed by the Department of Defense (DoD) over the past decade from experiences in Afghanistan and Iraq may be lost. This would have implications for the quality of trauma care both within the DoD and in the civilian setting, where adoption of military advances in trauma care has become increasingly common and necessary to improve the response to multiple civilian casualty events. Intentional steps to codify and harvest the lessons learned within the military's trauma system are needed to ensure a ready military medical force for future combat and to prevent death from survivable injuries in both military and civilian systems. This will require partnership across military and civilian sectors and a sustained commitment from trauma system leaders at all levels to assure that the necessary knowledge and tools are not lost. A National Trauma Care System defines the components of a learning health system necessary to enable continued improvement in trauma care in both the civilian and the military sectors. This report provides recommendations to ensure that lessons learned over the past decade from the military's experiences in Afghanistan and Iraq are sustained and built upon for future combat operations and translated into the U.S. civilian system. Table of ContentsFront MatterAbstractSummaryPart I: Introduction, Overview, and Framework1 Introduction2 Overview of Contemporary Civilian and Military Trauma Systems3 A Framework for a Learning Trauma Care SystemPart II: Assessment4 Generating and Applying Knowledge to Improve Trauma Outcomes5 Creating and Sustaining an Expert Trauma Care Workforce6 Delivering Patient-Centered Trauma Care7 Leveraging Leadership and Fostering a Culture of LearningPart III: Recommendations8 A Vision for a National Trauma Care SystemAppendixesAppendix A: Case StudiesAppendix B: Committee Collective Analysis of Case StudiesAppendix C: MilitaryCivilian Exchange of Knowledge and Practices in Trauma CareAppendix D: Military and Civilian Trauma Care in the Context of a Continuously Learning Health SystemAppendix E: Public Committee Meeting AgendasAppendix F: Committee Biosketches