Evaluation of military trauma system practices related to damage-control resuscitation
ABSTRACT 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.
- SourceAvailable from: Ricardo Navarro SuayRevista 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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ABSTRACT: Military conflicts create a dynamic medical environment in which the number of severe trauma cases is compressed in both time and space. In consequence, lessons are learned at a rapid pace. Because the military has an effective organizational structure at its disposal and the logistical capacity to rapidly disseminate new ideas, adoption of novel therapies and protective equipment occurs quickly. The recent conflicts in Iraq and Afghanistan are no exception: more than three dozen new clinical practice guidelines were implemented by the US Armed Forces, with attendant survival benefits, in response to observation and research by military physicians. Here we review the lessons learned by coalition medical personnel regarding resuscitation of severe trauma, integrating knowledge gained from massive transfusion, autopsies, and extensive review of medical records contained in the Joint Theater Trauma Registry. Changes in clinical care included the shift to resuscitation with 1:1:1 component therapy, use of fresh whole blood, and the application of both medical devices and pharmaceutical adjuncts to reduce bleeding. Future research will focus on emerging concepts regarding coagulopathy of trauma and evaluation of promising new blood products for far-forward resuscitation. New strategies aimed at reducing mortality on the battlefield will focus on resuscitation in the pre-hospital setting where hemorrhagic death continues to be a major challenge.Transfusion Clinique et Biologique 04/2013; · 0.67 Impact Factor