Military-to-civilian translation of battlefield innovations in operative trauma care

Authors

Adil H. Haider, Brigham & Women's Hospital, Boston, MAFollow
Lydia C. Piper, The Johns Hopkins University School of Medicine, Baltimore, MD
Cheryl K. Zogg, Brigham & Women's Hospital, Boston, MA
Eric B. Schneider, The Johns Hopkins University School of Medicine, Baltimore, MD
Jean A. Orman, Uniformed Services University of Health Sciences, Washington, DC
Frank K. Butler, Uniformed Services University of Health Sciences, Bethesda, MD

Document Type

Article

Department

General Surgery

Abstract

Background: Historic improvements in operative trauma care have been driven by war. It is unknown whether recent battlefield innovations stemming from conflicts in Iraq/Afghanistan will follow a similar trend. The objective of this study was to survey trauma medical directors (TMDs) at level 1-3 trauma centers across the United States and gauge the extent to which battlefield innovations have shaped civilian practice in 4 key domains of trauma care.
Methods: Domains were determined by the use of a modified Delphi method based on multiple consultations with an expert physician/surgeon panel: (1) damage control resuscitation (DCR), (2) tourniquet use, (3) use of hemostatic agents, and (4) prehospital interventions, including intraosseous catheter access and needle thoracostomy. A corresponding 47-item electronic anonymous survey was developed/pilot tested before dissemination to all identifiable TMD at level 1-3 trauma centers across the US.
Results: A total of 245 TMDs, representing nearly 40% of trauma centers in the United States, completed and returned the survey. More than half (n = 127; 51.8%) were verified by the American College of Surgeons. TMDs reported high civilian use of DCR: 95.1% of trauma centers had implemented massive transfusion protocols and the majority (67.7%) tended toward 1:1:1 packed red blood cell/fresh-frozen plasma/platelets ratios. For the other 3, mixed adoption corresponded to expressed concerns regarding the extent of concomitant civilian research to support military research and experience. In centers in which policies reflecting battlefield innovations were in use, previous military experience frequently was acknowledged.
Conclusion: This national survey of TMDs suggests that military data supporting DCR has altered civilian practice. Perceived relevance in other domains was less clear. Civilian academic efforts are needed to further research and enhance understandings that foster improved trauma surgeon awareness of military-to-civilian translation

Comments

This work was published before the author joined Aga Khan University

Publication (Name of Journal)

Surgery

Recommended Citation

Haider, A. H., Piper, L. C., Zogg, C. K., Schneider, E. B., Orman, J. A., Butler, F. K. (2015). Military-to-civilian translation of battlefield innovations in operative trauma care. Surgery, 158(6), 1686-1687.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_surg_gen/370