The primary goal of a trauma system is to diminish or eliminate the risk of death or permanent disability following traumatic events.
In the U.S., the National Academy of Sciences white paper of 1966, titled Accidental Death and Disability: The Neglected Disease of Modern Society, documented how the development of EMS systems, as well as the concept and initial development of trauma systems as we know them, was actually brought on in large part by the advances seen in trauma care in both the Korean and Vietnam Wars. This initial development phase was even further solidified in the civilian world by the wars in Afghanistan and Iraq.
The collective experience of those wars has created an unprecedented opportunity for civilian U.S. trauma systems to implement significant and substantial lessons in trauma care culled from the military experience.
Recognizing this, and working with a slate of subject matter experts, the National Academies of Sciences, Engineering and Medicine recently released a report, titled A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury, which speaks specifically to how the U.S. can take these “battlefield lessons” and apply them to the civilian sector.1 Speaking to this, the tables included in the beginning of this report are structured in a way that allow for a direct comparison of various trauma-specific military sector findings and civilian sector findings.
The report, which is over 400 pages long, calls for a national trauma care system to promote learning across the healthcare spectrum—from an injury scene to hospitalization, rehabilitation and afterward—and makes a strong case for statistically valid research into the treatment for trauma injuries, noting that injury research drew less than 1% of the National Institutes of Health’s biomedical research budget in 2015.
The report found that specific areas of civilian trauma care—specifically inconsistency in trauma care quality over time and geographic location, suboptimal transitions between phases of care and diffusion of responsibility—impede the process of continuous improvement and consistent adoption of military lessons learned in the civilian sector, where the burden of traumatic injury is staggering.
EMS has seen the effects of traumatic injury time and again but many do not realize that trauma is the leading cause of death for Americans under the age of 46. Traumatic injury also accounts for approximately half of all deaths in this age group and was associated with an economic cost of approximately $670 billion in medical care expenses and lost productivity in 2013 alone.
Many of the recommendations in the report will have some impact on EMS systems, and some will have significant impact. These recommendations include:
Recommendation three points out critical specific failings in clarifying responsibility and authority for trauma care in the civilian sector and how state, county and municipality leadership works against the achievement of national goals or consistent practices. No single federal entity is accountable for trauma care capabilities in the United States. At the national level, coordinating bodies and processes are fragmented and severely under resourced for the magnitude of the task. This includes a lack of funding for ASPRs Emergency Care Coordination Center, the lack of resources for the National Highway Traffic Safety Administration’s (NHTSA) Office of EMS and the lack of both funding and authority that the Federal Interagency Committee on EMS (FICEMS) has to fulfill its mission.
Recommendation five specifically mentions the Office of the National Coordinator for Health Information Technology working to improve the integration of prehospital and in-hospital trauma care data into electronic health records for all patient populations, including children. This recommendation specifically mentions the American College of Surgeons (ACEP), NHTSA and the National Association of State EMS Officials (NASEMSO) collaborating to enable patient-level linkages across the National EMS Information System project’s National EMS Database and the National Trauma Data Bank.
Recommendation 10 calls for EMS to be included as a key component of the healthcare system rather than being viewed as merely a transport mechanism, with specific recommendations amending both the Social Security Act and the CMS Ambulance Fee Schedule, making HHS responsible for EMS and conducting a national EMS needs assessment. This specific recommendation has the potential to be cause tremendous paradigm shift for EMS systems as they move beyond just being paid for transportation and could include greater opportunities for EMS to become involved in prevention activities and other areas.
The report takes both a strategic and tactical approach, outlining both what senior-level decision makers (such as the White House and the Secretary of Health and Human Services) can do to advance the report’s findings while, at the same time, delving into more granular aspects of trauma care.
The implications of this report are myriad and include policy, clinical as well as potentially reimbursement. But, if the identified partnerships between civilian and military decision makers aren’t solidified, and the lessons learned are not put into action, this report will just become one more in a long list of critical reports complied by subject matter experts that get ignored and tucked away.
Raphael M. Barishansky, MPH, MS, CPM, is a solutions-driven consultant working with EMS agencies, emergency management and public health organizations on complex issues including leadership development, strategic planning, policy implementation and regulatory compliance. He previously served as director of the Office of Emergency Medical Services (OEMS) at the Connecticut Department of Public Health (2012–15), as well as chief of public health emergency preparedness at the Prince George’s County (MD) Health Department (2008–12). A frequent contributor to and editorial advisory board member for EMS World, he can be reached at email@example.com.