American College of Surgeons Commits to Preventing 30,000 Trauma Deaths per Year
Trauma leaders and experts at the 2016 Clinical Congress of the American College of Surgeons (ACS) committed to work with partners to achieve zero preventable military and civilian deaths from trauma. Reaching that goal, established in a June 2016 report by the National Academies of Science, Engineering and Medicine (NASEM), would save an estimated 30,000 lives per year.
The NASEM report, "A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths," calls on military, government and health care leaders to jointly establish a coordinated national trauma system. The report outlines 11 recommendations that would help the nation realize the vision that "the first casualties of the next war would experience better outcomes than the casualties of the last war, and all Americans would benefit from the hard-won lessons learned on the battlefield."
The battlefield has long been a source of innovation in trauma care, and the percent of fatalities among all wounded service members dropped significantly in recent decades – from 23 percent during the Vietnam War to 9.3 percent in Afghanistan and Iraq – but according to the report, despite better outcomes, gaps in care have cost lives.
ACS has focused on efforts to improve care for injured patients since it formed the Committee on Trauma (COT) in 1922 (then known as the Committee on Fractures). Today, the Committee on Trauma, administered by an 85-member leadership team and 3,500 regional surgeon leaders, oversees a spectrum of initiatives aimed at advancing the standard of trauma care for practitioners, trauma centers, and trauma systems. These initiatives include Levels I-IV trauma center verification, the nation's only risk-adjusted outcomes-based trauma quality program, and trauma courses taken by more than a million medical professionals globally.
"Currently, few systems are in place to transfer best practices and innovations between military and civilian trauma systems," said Col. Jeffrey A. Bailey, MD, FACS, Walter Reed National Military Medical Center. And, according to M. Margaret (Peggy) Knudson, MD, FACS, Medical Director of the Military Health System Strategic Partnership American College of Surgeons (MHSSPACS), "Surgeons who return home to practice at military hospitals may see far fewer trauma patients and, as a result, may not have the skills and readiness to quickly return to the warfront should they be called to serve."
Eileen M. Bulger, MD, FACS, member of the executive committee of the ACS COT, said, "In order to drive new innovation we need to establish a stronger system of data sharing nationally, ensure all hospitals providing trauma care are collecting robust data, and coordinate a national research plan with dedicated support and funding for clinical trials."
Death from Injury Continues to be a Public Health Crisis
NASEM first drew attention to accidental death and disability as a public health crisis in 1966, when it issued a report that was pivotal in driving early development of trauma systems across the United States. Yet 50 years later, the U.S. still does not have a coordinated national trauma system.
Trauma continues to be the leading cause of death in the U.S. for those ages 1-46 years old, accounting for nearly half of all deaths in this age group and more loss of years of life than any other illness or disability. According to the report released in June, one-third of Americans do not live within one hour of a Level I trauma center, the highest level of trauma care for the severely injured.
"Americans believe that they are part of a coordinated trauma system, but the reality is, the care you receive is highly dependent on where you live," said Robert J. Winchell, MD, FACS, Chair, ACS Trauma Systems Evaluation and Planning Committee. "State and regional governments prioritize trauma care differently and there are varying sources of coordination and funding. Despite the significant public health implications, trauma care hasn't become a consistent priority in all states."
Once patients arrive at a trauma center, compliance with available guidelines is highly variable from region to region, even though evidence shows patients who receive trauma care according to recommended best practices are 58 percent less likely to die than patients who do not. About half of trauma deaths occur at the scene or in route to the hospital, yet pre-hospital care also is highly variable. "Over the past five decades we've seen the rate of death from injury drop dramatically as our trauma system has advanced. Those who have access to optimal trauma care have significantly greater chances of surviving injury than they would have had a generation ago," said Dr. Stewart. "But because our patchwork of trauma systems has no national coordination, far too many people don't have access to optimal care, leading to tens of thousands of unnecessary deaths each year."
According to the report, up to one in five civilian trauma deaths and a quarter of military trauma deaths could be prevented if all injured patients receive appropriate care.
ACS Committee on Trauma to Convene Leading Organizations to Support National Trauma System
Early next year, the ACS COT along with partner organizations will hold an "Innovations in Trauma Care Conference" to convene national stakeholders in addressing the gaps highlighted by the NASEM report. ACS will also advocate for national support, leadership, and funding, as well as a coordinated national trauma research plan.
"We want to enable local regions to establish systems of care that address their unique needs, yet this needs to be done in a uniform way to ensure we address significant gaps," said Donald H. Jenkins, MD FACS, member of the executive committee of the ACS Committee on Trauma.