Evaluation of military trauma system practices related to damage-control resuscitation

From the US Army Institute of Surgical Research, Fort Sam Houston, Texas.
The journal of trauma and acute care surgery 12/2012; 73(6 Suppl 5):S459-64. DOI: 10.1097/TA.0b013e3182754887
Source: PubMed


The Joint Theater Trauma System (JTTS) was developed with the vision that every soldier, marine, sailor, and airman injured on the battlefield would have the optimal chance for survival and maximum potential for functional recovery. In this analysis, we hypothesized that information diffusion through the JTTS, via the dissemination of clinical practice guidelines and process improvements, would be associated with the acceptance of evidence-based practices and decreases in trauma practice variability.
The current evaluation was designed as a single time-series quasi-experimental study as a preanalysis and postanalysis relative to the implementation of clinical practice guidelines and process improvement interventions. Data captured from patients admitted to hospital-level (Level III) military treatment facilities in Iraq and Afghanistan from 2003 to 2010 were retrospectively analyzed from the Joint Theater Trauma Registry (JTTR) to determine the potential impact of process improvement initiatives on clinical practice.
The JTTS clinical practice guidelines for massive transfusion led to increased compliance with balanced component transfusion and decreased practice variability. During the course of the evaluation period, hypothermia on presentation decreased dramatically after the publication of the hypothermia prevention and management clinical practice guideline.
Developed metrics demonstrate that evidence-based quality improvement initiatives disseminated through the JTTS were associated with improved clinical practice of resuscitation following battlefield injury.
Therapeutic/care management study, level IV.

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    • "Whatever, the DCS has switched in two decades from a concept to a shared surgical practice, as far as it has convinced the trauma center surgical teams to include it in their daily practice. Undoubtedly developments made are largely a consequence of analysis of data held in the US and UK Joint Theater Trauma Registry, demonstrating audit at its best, with results quickly converted into practice (Iraq and Afghanistan have unfortunately permitted important cohort studies) [7]. "
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    ABSTRACT: The purpose of this review is to present the progressive extension of the concept of damage control resuscitation, focusing on the prehospital phase. Review of the literature in Medline database over the past 10years. Medline database looking for articles published in English or in French between April 2002 and March 2013. Keywords used were: damage control resuscitation, trauma damage control, prehospital trauma, damage control surgery. Original articles were firstly selected. Editorials and reviews were secondly studied. The importance of early management of life-threatening injuries and rapid transport to trauma centers has been widely promulgated. Technical progress appears for external methods of hemostasis, with the development of handy tourniquets and hemostatic dressings, making the crucial control of external bleeding more simple, rapid and effective. Hypothermia is independently associated with increased risk of mortality, and appeared accessible to improvement of prehospital care. The impact of excessive fluid resuscitation appears negative. The interest of hypertonic saline is denied. The place of vasopressor such as norepinephrine in the early resuscitation is still under debate. The early use of tranexamic acid is promoted. Specific transfusion strategies are developed in the prehospital setting. It is critical that both civilian and military practitioners involved in trauma continue to share experiences and constructive feedback. And it is mandatory now to perform well-designed prospective clinical trials in order to advance the topic.
    Annales francaises d'anesthesie et de reanimation 07/2013; 32(7). DOI:10.1016/j.annfar.2013.07.012 · 0.84 Impact Factor
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    Revista espanola de anestesiologia y reanimacion 01/2013; 61(8). DOI:10.1016/j.redar.2013.11.005
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    ABSTRACT: Vladimir A. Oppel (1872-1932) was a forefather of military trauma systems. As a surgeon in the Russian Army in World War I, Oppel experienced the challenges and inefficiencies associated with caring for large numbers of combat wounded, the inefficiencies he observed leading to unacceptable morbidity and mortality. As a consequence, Oppel envisioned a coordinated sequence of surgical care on the battlefield and developed the concept of "targeted evacuation." In his work, Oppel was among the first to propose the "right operation for the right patient at the right location at the right time." Central to Oppel's precepts were (1) the forward positioning of surgical care close to the point of injury, (2) the development of a reserve of proficient and deployable military surgeons, and (3) the provision of specialized surgery to optimize survival and reduce morbidity. Oppel's teachings were validated during World War II in the performance of the Soviet casualty evacuation system and in all modern wars modern since. Today, nearly 100 years after the work of Vladimir Oppel, the benefits of a coordinated or "targeted" trauma system, working to optimize survival after trauma, are well recognized around the world.
    04/2013; 74(4):1178-81. DOI:10.1097/TA.0b013e3182858407
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