Background
Historic improvements in operative trauma care have been driven by war. It is unknown
whether recent battlefield innovations stemming from conflicts in Iraq/Afghanistan
will follow a similar trend. The objective of this study was to survey trauma medical
directors (TMDs) at level 1–3 trauma centers across the United States and gauge the
extent to which battlefield innovations have shaped civilian practice in 4 key domains
of trauma care.
Methods
Domains were determined by the use of a modified Delphi method based on multiple consultations
with an expert physician/surgeon panel: (1) damage control resuscitation (DCR), (2)
tourniquet use, (3) use of hemostatic agents, and (4) prehospital interventions, including
intraosseous catheter access and needle thoracostomy. A corresponding 47-item electronic
anonymous survey was developed/pilot tested before dissemination to all identifiable
TMD at level 1–3 trauma centers across the US.
Results
A total of 245 TMDs, representing nearly 40% of trauma centers in the United States,
completed and returned the survey. More than half (n = 127; 51.8%) were verified by the American College of Surgeons. TMDs reported high
civilian use of DCR: 95.1% of trauma centers had implemented massive transfusion protocols
and the majority (67.7%) tended toward 1:1:1 packed red blood cell/fresh-frozen plasma/platelets
ratios. For the other 3, mixed adoption corresponded to expressed concerns regarding
the extent of concomitant civilian research to support military research and experience.
In centers in which policies reflecting battlefield innovations were in use, previous
military experience frequently was acknowledged.
Conclusion
This national survey of TMDs suggests that military data supporting DCR has altered
civilian practice. Perceived relevance in other domains was less clear. Civilian academic
efforts are needed to further research and enhance understandings that foster improved
trauma surgeon awareness of military-to-civilian translation.
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Article info
Publication history
Published online: July 23, 2015
Accepted:
June 11,
2015
Identification
Copyright
© 2015 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
