Implementation and Dissemination of a Military Trauma System: Utilizing Medical Lessons Learned from the Battlefield
Abstract
Derived from the necessity to mitigate injury outcomes across the spectrum of battlefield injury, the Joint Theater Trauma System (JTTS) and Joint Theater Trauma Registry (JTTR) were developed utilizing the American College of Surgeons Committee on Trauma Optimal Resources model in accordance with the U.S. civilian trauma system approach. This analysis was developed to highlight successes of the JTTS. The JTTR captured demographic, mechanistic, physiologic, diagnostic, therapeutic, and outcome data on 23,754 casualty injury events from October 2001 through December 2008 for this analysis. In contrast to civilian trauma systems, the majority of battlefield wounds were penetrating mechanism (66.4%). Of patients admitted to deployed military medical treatment facilities, 23.4% had an injury severity score (ISS) >/=16, 21+/-4% presented in shock (base deficit >5), 30+/-3 % patients required blood and 6.8+/-2% required massive transfusion. In response to this complex and severely injured population, the JTTS remedied numerous trauma system issues requiring system leadership and advocacy, education, research, and alterations in clinical care, including the elaboration of 31 evidence-based clinical practice guidelines. Several of the guidelines including those for massive transfusion / damage control resuscitation, burn care, hypothermia prevention and management, wound and amputation management have been associated with demonstrable improvements in combat injury outcomes. The JTTS developed a novel performance improvement process across the global continuum of care, a process responsible for improved battlefield injury survival, notably a mortality rate of 4.1% after admission which is comparable to the U.S. civilian standards. In addition, the JTTS fostered the development of military trauma systems and combat trauma registries in several NATO coalition partners including Canada and the United Kingdom.
Document Details
- Document Type
- Technical Report
- Publication Date
- Apr 01, 2010
- Accession Number
- ADA581930
Entities
People
- Brian Eastridge
- George Costanzo
- Lorne H Blackbourne
- Mary A. Spott
Organizations
- United States Army Institute of Surgical Research