WASHINGTON – Preventable deaths of soldiers on the battlefield and also of civilians in the cities and streets of the U.S. could be reduced under a proposed House bill offering grants for civilian trauma centers to hire military doctors and staff.
In a recent report, the National Academies of Sciences, Engineering and Medicine suggested the White House lead an effort to integrate military and civilian trauma systems in a bid to decrease deaths by severe injuries on both sides.
The idea would be to use military staff in the civilian trauma system so both sides could share information about treating trauma in life-or-death situations. Knowledge would flow smoother from the military to the civilian sector during times of war, and vice versa during peacetime.
“Trauma is an incredibly intense environment when somebody comes in and their life depends on decisions that you’re going to make in a matter of minutes or seconds,” said Col. Jennifer Gurney, an active duty trauma surgeon with the U.S. Army Institute of Surgical Research. “If you’re not doing that regularly, it’s not just your technical skills, it’s your critical thinking skills and decision-making skills [that deteriorate].”
According to the national academies report, trauma deaths – fatal injuries like gunshot wounds or car accidents – of approximately 1,000 service members in the Iraq and Afghanistan conflicts between 2001 and 2011, and about 20 percent civilian ones at home in 2014 could have been prevented with more proficient trauma care.
The concern is that during peacetime, military physicians may get rusty away from the intensity of the battlefield. When war comes, some surgeons may not be fully prepared for the rigors of the battlefield.
“Don’t blame the individual physician or nurse as the military has little to almost no opportunity (in peacetime) for military teams to care for severe trauma,” Dr. C. William Schwab testified before a House Energy and Commerce health subcommittee. Schwab was trained as a surgeon in the U.S. Navy during the Vietnam War and has been training trauma care providers on both the military and the civilian sides for about 40 years.
Currently, the trauma center in San Antonio Military Medical Center is the only Level I trauma center, the highest level in terms of medical capability under the Department of Defense.
The House proposed bill seeks to authorize grants of up to $20 million per year to civilian trauma centers — $1 million each at most for as many as 20 centers — so they can incorporate full-time military trauma teams. Such integration would allow military trauma practitioners more exposure in managing trauma cases – victims of violent crime or serious household accidents, for instance — in the civilian world.
The national academies report, which Schwab helped write, says the mean age of front-line military surgeons is 36 at the time of deployment, with an average of two years of board certification. Most medical personnel had little experience in a high volume civilian trauma center. The legislation in question would change that.
The U.S. military has made many advances in battlefield trauma care over the last two decades, including tourniquet use and damage control resuscitation, as well as improvements in evacuation systems and communication. Some of the changes have been adopted by the civilian system, said Dr. Gurney.
“As the operational tempo decreases, we have to look at how we’re going to maintain currency and competency in trauma care,” said Gurney. “We really have to look at our civilian hospitals, especially some underserved ones. We should be working there, we should be contributing to the care of trauma populations, because that benefits the civilian hospitals and benefits us by keeping us current.”