Military and Civilian Joint Research Gaps

1
Military and CivilianJoint Research Gaps

• COL. Brian Eastridge, MD, FACS, USAISR
• Stephen Cohn, MD, FACS, UTHSCSA

2
The Civilian Trauma Problem

• 61 of the deaths of Americans between the ages
  of 1 and 44 each year.
• More than all forms of cancer, heart disease,
  HIV, liver disease, stroke and diabetes combined.
  
• An American dies every three minutes due to
  trauma
• 179,000 deaths every year
• 29.6 million injuries every year

• The Top Eight Causes of Death in Americans Aged
  1-44 Years

CDC, 2007
3
The Civilian Trauma Problem

• Second most expensive public health problem
  facing the USA
• The leading cause of years of productive life
  lost
• Annual medical costs from trauma 72 billion
  (AHRQ, 2005)
• Second only to heart conditions
• True economic burden may be more than 690
  billion per year due to cost of disability
• (National Safety Council, 2011)

AHRQ, 2005
4
The Civilian Trauma Problem

• Can research really make a difference?
• 50 years of dedicated research into proper
  diagnosis and treatment of leukemia has led to an
  80 reduction in the death rate
• A 5 reduction in trauma deaths, injuries and
  economic burden would
• save the United States 35 billion
• prevent 1.5 million injuries
• save 9,000 lives
• EVERY YEAR

5
Civilian Trauma Research Gaps

• Hemorrhage
• Identification and control of non-compressible
  hemorrhage
• Endpoints for resuscitation with hemorrhagic
  shock
• Major hemorrhage from pelvic fractures
• Intra-cranial bleeding with coagulopathy
• Novel resuscitation fluids for hemorrhagic shock
• Hemostatic devices
• Control of bleeding in thoracic outlet, groin,
  retrohepatic area and pulmonary hilum

6
Civilian Trauma Research Gaps

• Intensive Care
• Tracheostomy in patients requiring prolonged
  mechanical ventilation
• Prevention of thromboembolic occurrences and
  complications
• Increasing ventilator-free days and lowering
  costs and complications

7
Civilian Trauma Research Gaps

• Burn
• Replacement and off-the-shelf skin
• Protecting skin grafts from immune recognition
• Pain management

8
Civilian Trauma Research Gaps

• Hospital Acquired Infection and Antibiotic
  Utilization
• Rapid methods for detection and identification of
  infection
• Methods for minimization of transmission

9
Civilian Trauma Research Gaps

• Disaster Preparedness
• Procedures or treatment in mass casualty
  situations
• Safe and cost-effective transport protocols for
  critically injured patients

10
Civilian Trauma Research Gaps

• Technology development
• Wireless vital signs monitors
• Biosensors
• Imaging systems for improved trauma care
• Computerized clinical decision support systems
• ICU monitoring
• Resuscitation
• Antibiotic prescription and monitoring
• Organ simulation for medical education

11
Military/Civilian Common Challenges

• Military

• Civilian

• Hemorrhage/coagulopathy Hemorrhage/coagulopathy
• Burn Burn
• Wound infection Hospital-acquired infection
• Transportation of the critically ill Disaster
  preparedness
• Orthopaedic trauma Orthopaedic trauma
• TBI TBI
• Pain management Intensive Care
• Secondary cell and organ damage Technology
  development
• Massive soft tissue injury
• Eye, ear, craniofacial injury
• Pre-hospital data

12
Research Gaps - Conclusion

• Were working on the same problems
• Collaboration makes sense
• NTI provides a good way to enhance
  military/civilian partnership/interaction
• Powerful impact by working together
• Better transfer of knowledge between civilian and
  military benefits both