Researchers call for combining the efforts of military and civilian trauma systems to “achieve zero preventable deaths” after traumatic injury and mass casualty events.
Hospitals need to consider emergency medical teams as care providers, not just ambulance drivers, according to a new report from the National Academies of Sciences on the lessons for civilians from combat trauma care.
The report, released last week, calls for combining the efforts of military and civilian trauma systems to “achieve zero preventable deaths after injury” and notes that recent “mass casualty incidents” lend urgency to the effort.
“You saw what happened in Orlando,” committee chairman Donald Berwick, MD, said during a live, online teleconference on release of the report.
“You saw what happened with the marathon bombings in Boston. Those improvements largely rest on lessons learned in the military that were effectively brought into the design and conduct of civilian emergency responses.”
Berwick, a former Centers for Medicare & Medicaid Services administrator, is a senior fellow at the Institute for Healthcare Improvement in Cambridge, MA.
Despite innovations and improved outcomes, and an estimate that 20% of trauma-related deaths are preventable, the report authors note that there are “serious limitations in the thoroughness of the diffusion of those gains…”
Goal: Zero Preventable Deaths
The researchers found that accountability for civilian trauma care capabilities is “fragmented” and variable “resulting in a patchwork of systems for trauma care in which mortality varies twofold between the best and worst trauma centers in the nation.”
The report calls on the White House to set a national goal of zero preventable deaths and to act as a convener of the many public and private entities involved trauma care. Recommendations also call for efforts to develop best practices and improve electronic medical systems and research programs.
Furthermore, the report calls for the formal designation of EMS programs as care providers, not just as transporters. And the report calls on CMS to modify ambulance payments to better link the quality of prehospital care to payment and reform efforts.
“We can’t get the job of zero preventable deaths done without thinking of trauma care as a system,” Berwick said.
“As important as hospital are in the system, it is important for them to think of themselves as part of a pathway of care that begins at the point of injury and includes prehospital as well a post-hospital care.”
David King, MD, is a surgeon at Massachusetts General Hospital in Boston who served with the Army in Afghanistan and Iraq. He was on his way home after running the 2013 Boston Marathon when he heard news of the explosions and headed back into town to help with the victims.
He said many of the report’s recommendations have been proposed before, but “like any other unfunded mandate, they go nowhere.”
King agrees that prehospital care needs to be better integrated into the system so patients can be tracked from injury to rehab or death. Scanning data from prehospital reports into an electronic medical records system can be a challenge, for example.
King supports the idea of White House leadership on the issue.
“Individually, no one is going to do it,” he said in a phone interview. “There needs to be high level government leadership for this, with funding, to make it happen.”
King is involved in The Hartford Consensus, a group formed after the 2012 Newtown shootings to examine medical readiness for mass casualties. The group identified uncontrolled bleeding or hemorrhage as a major cause of death in these incidents and launched a program called “Stop the Bleeding” that promotes the use of tourniquets and “bleeding control kits” by both first responders and bystanders.
He doesn’t think that the Orlando shooting this month—the deadliest mass shooting in US history—or general concerns about gun violence have generated any momentum for the effort to improve the trauma system.
“If there is, I don’t’ feel it,” he said.
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