Proposal seeks formation of military trauma teams at civilian medical centers

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Oo Cipher oO

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http://www.militarytimes.com/story/...field-trauma-doctor-combat-medicine/87006694/

The House proposal, which has not been formally introduced, seeks to authorize grants of up to $20 million per year to civilian trauma centers — as much as $1 million each for as many as 20 centers — so they can incorporate full-time military trauma teams.

In a recent report, the National Academies of Sciences, Engineering and Medicine suggested the White House lead an effort to integrate military and civilian trauma systems in a bid to decrease deaths by severe injuries — such as gunshot wounds or car accidents — on both sides.

According to the report, trauma deaths of about 1,000 service members in the Iraq and Afghanistan conflicts between 2001 and 2011 could have been prevented with more proficient trauma care. About 20 percent of civilian deaths from serious injuries at home in 2014 could have been prevented as well.

The concern is that during peacetime, military physicians don't get regular exposure to the level of serious injuries seen on the battlefield and in busy civilian trauma centers and therefore are left less prepared for the rigors of the combat environment when they return.

“Don’t blame the individual physician or nurse as the military has little to almost no opportunity [in peacetime] for military teams to care for severe trauma,” said Dr. C. William Schwab when he appeared before July 12 before the House Energy and Commerce health subcommittee. Schwab, a professor of surgery at the University of Pennsylvania, was trained as a surgeon in the Navy during the Vietnam War and has been teaching military and civilian trauma care providers for about 40 years.

The U.S. military has made many advances in battlefield trauma care over the last two decades, including tourniquet use and damage control resuscitation, as well as improvements in evacuation systems and communication. Some of the changes have been adopted by the civilian system, Gurney said.

“As the operational tempo decreases, we have to look at how we’re going to maintain currency and competency in trauma care,” Gurney said. “We really have to look at our civilian hospitals, especially some underserved ones. We should be working there, we should be contributing to the care of trauma populations, because that benefits the civilian hospitals and benefits us by keeping us current.”

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Don't get me wrong, I'm all for this. But I wonder about this:

"According to the report, trauma deaths of about 1,000 service members in the Iraq and Afghanistan conflicts between 2001 and 2011 could have been prevented with moreproficient trauma care."

Who made that determination? Because of it's like any of the QC at any of the hospital's I've worked at, it might be some serious armchair quarterbacking, which I find almost always ignores systemic shortfalls.
 
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And who replaces these teams when start emptying those trauma rooms with deployments?
 
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I remember when that report came out. It was classic guesswork designed to reach a desired conclusion (this proposal) and ignored any battlefield realities (they basically said, well if you died from an extremity wound, you should have been saved since that was a "survivable" wound. Of course, the fact that you were outside a FOB in Helmand and only had buddy aid wasn't included in the analysis). If only we had Star Trek style teleportation, fewer people would die. No ****. I just don't accept that there were large numbers of patients who reached the trauma bay alive who didn't survive. That part of the military medical system isn't broken.

The whole thing is self-serving. The idea that seeing the typical blunt trauma that makes up most of a trauma center's work with the occasional low-velocity penetrating trauma is going to keep a military surgeon ready for combat injuries is a farce. Particularly when most of the surgeons doing trauma in theater are general surgeons. These guys train up fast when the time comes. Stupid plan.
 
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Well they may not see as many blast injuries, but I imagine if you put a team in Cook County they'd probably see quite a few gunshot wounds - even high velocity gunshot wounds. I mean, there are way more Americans dying in Chiraq than Afghanistan. But I'm for it for no other reason than that I think we should all be posted at civilian hospitals rather than these slop houses we call hospitals. I did five exploratory surgeries from gunshot wounds in 3 months at the county hospital as a resident. I've done exactly zero since finishing residency. And no one does a lot of facial trauma downrange, but I know guys at civilian community hospitals who do more than I do.
 
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I'm assuming they'd just be sending surgeons to trauma centers for a couple months a year? Probably anesthesiologists as well. I'm sure the trauma centers would like the money, but I wonder how well the physicians would integrate into these hospitals just rotating through, likely taking time away from resident learning.
 
I met an AF doc, trauma surgeon I think, who is on active duty and assigned to Maryland Shock Truama as his regular gig.
 
I'm assuming they'd just be sending surgeons to trauma centers for a couple months a year? Probably anesthesiologists as well. I'm sure the trauma centers would like the money, but I wonder how well the physicians would integrate into these hospitals just rotating through, likely taking time away from resident learning.
I'd think it would be fine. I've done ODE at hospitals with residents, and it certainly wasn't hard to integrate and actually help teach residents - and that's not on a recurring basis like this proposal would be. I mean, these guys are going for skill maintenance, not because they need to be taught how to care for trauma like a resident might.
 
Navy used to have a trauma surgeon billet at USC. Maybe we still do? Seemed to work out well, as a pseudo-permanent member of the faculty there.

You definitely can't just rotate people through for "skill maintenance" on a short term basis, however. Before deploying a few years ago, I went through the same place with a bunch of other doctors and nurses for a ~3 week trauma refresher course thing that included some lectures, some cadaver lab time, and some clinical time in their ER. The lectures and cadaver labs were pretty good, sometimes even excellent. The clinical time was worthless. Worse than worthless, actually. I had to stand in the ER and watch their residents commit malpractice while they and their staff ignored the board certified Navy surgeons and anesthesiologists standing there offering to help. They didn't want us there and after a few days I didn't want to be there. I sort of got in the habit of checking in for a clinical shift and then disappearing. LA can be fun if you have a lot of free time.
 
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You're talking about a trauma refresher course. Of course they're not going to have some random joker who paid a course entry fee hop in and run a trauma survey. What I am under the impression they are discussing is rotating through as a credentialed staff - part of the call pool. Apples and oranges. If the idea is to send them for a course, then I agree that it would be worthless. In my opinion and experience, most courses like that are only helpful if you're way out of touch with the standard of care. I don't need someone to remind me about anatomy or discuss the general algorithm for trauma care. If I'm going to handle trauma I need to do trauma cases, because it's the out-of-the-ordinary, non-algorithmic stuff that gets ya.

You could definitely send guys there on a relatively short term basis and get good results. 3 weeks is probably not enough time, but 4-6 weeks 1-2X/year would work out. If the trauma center was located more closely, they could simply take call with the rest of the trauma staff. - Again, as a credentialed staff member on a call rotation.

If they decide to do regular refresher courses it would be a waste of everyone's time and money.
 
I know in the anesthesia world, there are staff AF physicians at Shock Trauma ( I worked with them, at least in 2014), and supposedly in Cincinatti. I believe it is party of the CSTARS program. There also use to be Army personnel at Ryder in Miami, but I heard that was going away. My understanding of all these peeps were that they were assigned there, much like the suggestion of being in the call pool in the above statement. I caught wind of this possibility while deployed in '15 from some GS with an FST that worked heavily with SF. The possibility of working in a civilian trauma center and the new model FSRT were the 'hot topics' that were being thrown around at some level in the AMEDD. Though it sounded like it would be limited to surgery and only CRNAs and not anesthesiologists. Not sure why.
 
This has been around for as long as I've been in the military.

http://www.ncbi.nlm.nih.gov/pubmed/23192074

In fact my civilian medical school had one of these military trauma programs that consisted of 2 USAF trauma surgeons who were credentialed attendings carrying a full clinical workload at the civilian hospital and who also served as the directors of the 3 week ATLS refresher courses for all the activated reservist FPs and general surgeons who were rotated through on their way to deployment. The permanent party USAF surgeons seemed to like the gig ok, but the permanent "deer in the headlights" look of the activated reservists made me think they felt otherwise.
 
This has been around for as long as I've been in the military.

http://www.ncbi.nlm.nih.gov/pubmed/23192074

In fact my civilian medical school had one of these military trauma programs that consisted of 2 USAF trauma surgeons who were credentialed attendings carrying a full clinical workload at the civilian hospital and who also served as the directors of the 3 week ATLS refresher courses for all the activated reservist FPs and general surgeons who were rotated through on their way to deployment. The permanent party USAF surgeons seemed to like the gig ok, but the permanent "deer in the headlights" look of the activated reservists made me think they felt otherwise.

Yeah, I bet. I would imagine most of those guys hadn't done an ex-lap for major trauma in 15 years. It's a step from doing appys and gastric sleeves for a living to removing a 7.62 round from someone's liver.
 
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It's a step from doing appys and gastric sleeves for a living to removing a 7.62 round from someone's liver.

And ironically, my buddy (a trauma/CC trained surgeon on staff at a military hospital with a level I trauma designation) was so bored on his last deployment to Kuwait in 2015 that he started doing elective hernia repairs and cholecystectomies on SMs in theater to keep them from being evac'd to Landstuhl for surgery and to get in some OR time.
 
And ironically, my buddy (a trauma/CC trained surgeon on staff at a military hospital with a level I trauma designation) was so bored on his last deployment to Kuwait in 2015 that he started doing elective hernia repairs and cholecystectomies on SMs in theater to keep them from being evac'd to Landstuhl for surgery and to get in some OR time.
Yeah, I've heard that a lot. There is usually at least one "busy" FSH out there at any given point, but how busy is variable. And even then, usually more foreign nationals than US soldiers are coming through.
But that's part of the problem - they're not always getting experience, even when they are deploying. It's a crap shoot. Do you have to decide whether or not they need to be ready for major trauma. Clearly the answer is yes, otherwise what the hell are we doing?
 
I met an AF doc, trauma surgeon I think, who is on active duty and assigned to Maryland Shock Truama as his regular gig.
I know in the anesthesia world, there are staff AF physicians at Shock Trauma ( I worked with them, at least in 2014), and supposedly in Cincinatti. I believe it is party of the CSTARS program. There also use to be Army personnel at Ryder in Miami, but I heard that was going away. My understanding of all these peeps were that they were assigned there, much like the suggestion of being in the call pool in the above statement. I caught wind of this possibility while deployed in '15 from some GS with an FST that worked heavily with SF. The possibility of working in a civilian trauma center and the new model FSRT were the 'hot topics' that were being thrown around at some level in the AMEDD. Though it sounded like it would be limited to surgery and only CRNAs and not anesthesiologists. Not sure why.

I'm EM/CritCare and I'm assigned as permanent party at ShockTrauma.
 
Oh yeah? And how comparable do you feel your trauma experience is when compared to, say, SAMC? It's a level I trauma center, you know?

My last AD station was SAMMC :p
Acuity at ShockTrauma is definitely higher and the ratio of penetrating to blunt trauma is closer to warzone ratio than SAMMC.

With that said, from the ED side of things, SAMMC is a closer approximation of a deployed ED than ShockTrauma. Most of your day is spent taking care of not-emergent complaints with the occasional trauma alert thrown in. At Shock, it's traumatraumatrauma all day long.
 
My last AD station was SAMMC :p
Acuity at ShockTrauma is definitely higher and the ratio of penetrating to blunt trauma is closer to warzone ratio than SAMMC.

With that said, from the ED side of things, SAMMC is a closer approximation of a deployed ED than ShockTrauma. Most of your day is spent taking care of not-emergent complaints with the occasional trauma alert thrown in. At Shock, it's traumatraumatrauma all day long.
Yeah, I was being sarcastic. But good point on SA being more like deployment.
 
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