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Surgery. 2015 Dec;158(6):1686-95. doi: 10.1016/j.surg.2015.06.026. Epub 2015 Jul 23.

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

Author information

1
Center for Surgery and Public Health, Harvard Medical School and Harvard School of Public Health, Department of Surgery, Brigham & Women's Hospital, Boston, MA. Electronic address: ahhaider@partners.org.
2
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
3
Center for Surgery and Public Health, Harvard Medical School and Harvard School of Public Health, Department of Surgery, Brigham & Women's Hospital, Boston, MA.
4
Department of Medicine, Uniformed Services University of Health Sciences, Washington, DC.
5
Department of Military and Emergency Medicine, Uniformed Services University of Health Sciences, Bethesda, MD.
6
Department of Emergency Medicine, Brooke Army Medical Center, JBSA-Fort Sam Houston, Houston, TX.
7
Department of General Surgery, University of Miami/Jackson Memorial Medical Center, Miami, FL.
8
Department of Health Policy and Management, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
9
Department of Anesthesiology, Reading Health System, West Reading, PA.
10
Department of Surgery, University of Maryland School of Medicine, Baltimore, MD.
11
Department of Surgery, Brooke Army Medical Center, JBSA-Fort Sam Houston, Houston, TX.

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.

PMID:
26210224
DOI:
10.1016/j.surg.2015.06.026
[Indexed for MEDLINE]

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