Zero preventable deaths after traumatic injury: An achievable goal

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Trauma systems have been improving outcomes for patients with injuries for decades. Advancements have been made due to improvements in blood storage, prehospital and interhospital transport systems, and refinement of resuscitative and surgical techniques. Despite these improvements in trauma care, there are still many gaps that remain that impede further improving outcomes. These deficiencies have been difficult to address in part due to lack of a well defined and continuously learning health system for trauma that provides a universal means of improving care, education, research, and guiding the national leadership in health, defense, and other branches of government.
Civilian and military trauma systems have been developing and contributing simultaneously to the improvement of trauma systems over time, and it will take continued collaboration to achieve additional advancements in the future. The goal of improving outcomes for patients with traumatic injury and reducing unnecessary death and disability has always been a high priority. In the early 1990s after an analysis of outcomes from combat operations in Mogdishu, Somalia,1 two US military-led efforts have significantly guided the current goal of zero-preventable deaths after traumatic injury. First the US Tactical Combat Casualty Care Committee was developed with a goal of constructing a robust set of presurgical care guidelines that could be implemented by all military providers.2 Soon thereafter, the US Army Ranger’s implemented Tactical Combat Casualty Care Committee guidelines for presurgical care, with a goal of zero preventable deaths after traumatic injury.3 These goals were met due to a strong leadership culture, accountability, shared responsibility, extensive training, and maintenance of medical skills.4
These accomplishments have raised expectations and set an example for how to develop and implement best practice guidelines.2,3 Many excellent trauma systems are operational around the United States and the world, but what is still lacking is a highly organized approach to how these systems learn from their experiences and how it adapts with increasing knowledge. A learning health care system(s) (LHCS) (is the term used to describe a robust organized approach to improving outcomes by using an iterative process that continually examines patient data and outcomes in real time. In 2012, the National Academy of Sciences Engineering and Medicine published recommendations describing how a LHCS can provide best care at lower cost.5 The US Military Joint Trauma System (JTS) has many elements of a LHCS, and while care provided within the JTS has led to the best outcomes that have ever been recorded (case fatality rate [CFR] of 9.3 compared with 20–23 in Korean and Vietnam Wars), US military medicine leaders acknowledge that there is room for improvement.6
This review of a lecture presented at the Trauma Hemostasis and Oxygenation Research (THOR) Network’s 2016 RDCR Symposium provides highlights from the National Academy of Sciences, Engineering and Medicine’s Report on A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury.7 It is a brief summary of an extensive report that provides background information regarding the urgency for improving outcomes for patients with traumatic injury, potential solutions as well as barriers to improving outcomes, and how trauma systems can improve by using a LHCS model.
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