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Trauma Symposium Highlights Importance of Unified System

people train tourniquets on a volunteer
By Bernard S. Little, WRNMMC Command Communications

Focused on the theme “Building a Unified Civilian-Military Trauma System in the National Capital Region,” Walter Reed National Military Medical Center and the Uniformed Services University hosted the 2018 Trauma Symposium at WRNMMC and USU on Naval Support Activity Bethesda from April 17-19.

During the three-day event, presentations and activities highlighted the importance of trauma medicine and care “advancing together or not at all,” establishing a unity of efforts among trauma facilities throughout the nation, explained the symposium’s keynote speaker, Dr. C. William Schwab of the University of Pennsylvania in Philadelphia.

Schwab said he’s “hopeful” the NCR consider creating one trauma system for the region which would potentially serve as an example and the impetus for a national trauma care network.

He explained a strong reason for this is that “preventable death from injury is rampant in America. Twenty-five thousand to 30,000 deaths a year are preventable if we can optimize the delivery of hemorrhage control earlier to the trauma patient,” he furthered.

Emeritus professor of surgery at the Perelman School of Medicine and founding chief of the Division of Traumatology, Surgical Critical Care and Emergency Surgery, Schwab serves as senior consultant of Penn Medicine for the University of Pennsylvania Health System.

a panel in front of a screen
Army Col. (Dr.) Kyle N. Remick gives opening remarks April 17 at the 2018 Trauma Symposium hosted by the Department of Surgery at the Uniformed Services University and WRNMMC. (Image credit: Bernard S. Little, WRNMMC Public Affairs)

Internationally known for his work in damage control surgery and the care of complex trauma, Schwab served in the U.S. Navy during the Vietnam War. One of his assignments was at the National Naval Medical Center, a predecessor of WRNMMC, and he has fostered a technique called “Damage Control Surgery,” credited with increasing the numbers of service members surviving devastating injuries. He also works to reduce firearm-related injuries as founding director of Penn’s Firearm and Injury Center at Penn.

“Perhaps the best contribution to the public health of the latter 20th century was the American trauma system,” Schwab continued. “It greatly improved survival after critical injury,” added the physician who has worked in trauma surgery for approximately 40 years.

Schwab explained that with the advancement of the U.S. trauma system, challenges surfaced because there wasn’t a national lead establishing standards, policies, and a system framework for how trauma centers should operate. He said these national challenges resulted in “islands of excellence [with some regions having trauma services], patchwork with gaps [some regions not having conveniently located trauma services], and “uncontrolled proliferation without need-based assessment [growth and redundancies of trauma services in certain regions].”

Military medicine has greatly contributed to advances in trauma care, Schwab furthered. “War stimulates change, and certainly for medicine,” he continued. “The military created the most efficient, with the best outcomes, world-wide trauma system the likes of which we had never seen. They are the mass casualty experts,” he added.

Schwab also credits the military with doing something in trauma care that most states have not – creating data collection on the battlefield [at the point of injury] and linking it to every phase of care concurrently.

Despite its advances, Schwab said a difficulty for military medicine is maintaining its acuity between conflicts. “Many of the lessons learned quickly fall to the wayside as the Military Health System has to deal with other things,” he added.

Schwab stressed the importance of a national trauma system with “shared aims, infrastructure, system design, data, best practices and personnel” from the civilian and military trauma systems.

a woman training during a Stop The Bleed exercise
During the recent WRNMMC-USU Trauma Symposium, an attendee rushes to help save a “casualty.” The role-playing exercise allowed health care providers, students, and staff, to practice techniques to control severe blood loss in an emergency. (Image credit: Tom Balfour)

"Medicine is a team sport, and that's probably more important in trauma care than any other aspect of medicine," said retired Army Maj. Gen. (Dr.) Richard Thomas, USU president. He agreed that those who served on the battlefield in trauma care should take those lessons learned to move health care forward with their partnerships in the civilian community.

Navy Capt. (Dr.) Mark Kobelja, WRNMMC director, agreed, adding that in the NCR, civilian leaders, along with their military counterparts, have been focused "for decades on the needs of the nation, the needs of the combat forces, and support of the expeditionary medical forces. We have a fantastic system in the NCR that has always been task organized around integrated trauma care." Making this even more important now is that Congress passed legislation signed by the president calling for military medicine to become more integrated with civilian health care, not only to get the combat forces ready for their war mission, but also to better support the NCR region as the seed of the national government.

The three-day symposium also included panel discussion from leaders of trauma centers and systems throughout the NCR, as well as sessions addressing various trauma injuries and care. In addition, USU hosted Stop the Bleed training.

Manny Santiago, trauma/acute care surgery clinical nurse specialist, conducted the Stop the Bleed training during the symposium, explaining that uncontrolled bleeding is the No. 1 cause of preventable death from trauma. In addition, he said that the greater the number of people who know how to control bleeding of an injured patient, the greater the chances are of the patient surviving the injury. He also stressed the importance of a tourniquet to stopping the bleed, crediting it with saving numerous lives on the battlefield in recent years.

Also during the symposium, a number of speakers noted that Air Force and civilian surgeons worked alongside each other during the Oct. 1, 2017 mass shooting in Las Vegas, Nevada. The wounds of the injured were similar to those seen in war, motivating Las Vegas hospitals that treated the victims to reach out to military trauma surgeons for assistance in treating the injured.