The plan to keep military combat docs ready for America's next war

About 100 mortally wounded troops a year could have been saved in a decade of fighting in Iraq and Afghanistan if more military doctors had been more skilled in trauma care, a top medical organization reports, A proposal under consideration on Capitol Hill is directed at ensuring that military doctors gain and maintain proficiency in those skills by working with civilian trauma centers.

The proposal calls for grants for civilian trauma centers to hire military doctors and staff.

The idea would be to use military medical professionals in the civilian trauma system so both sides could share information about treating patients in life-or-death situations.
“Trauma is an incredibly intense environment when somebody comes in and their life depends on decisions that you’re going to make in a matter of minutes or seconds,” said Col. Jennifer Gurney, an active-duty trauma surgeon with the Army Institute of Surgical Research. “If you’re not doing that regularly, it’s not just your technical skills, it’s your critical thinking skills and decision-making skills” that deteriorate.
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.”