Military-to-civilian translation of battlefield innovations in operative trauma care Presented previously at the Pacific Coast Surgical Association 85th Annual Meeting, February 14-17, 2014, Dana Point, CA.

Adil H. Haider, Lydia C. Piper, Cheryl K. Zogg, Eric B. Schneider, Jean A. Orman, Frank K. Butler, Robert T. Gerhardt, Elliott Haut, Jacques P. Mather, Ellen J Mackenzie, Diane A. Schwartz, David W. Geyer, Joseph J. Dubose, Todd E. Rasmussen, Lorne H. Blackbourne

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1686-1695
Number of pages10
JournalSurgery
Volume158
Issue number6
DOIs
StatePublished - Dec 1 2015

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Physician Executives
Trauma Centers
Wounds and Injuries
Resuscitation
Research
Thoracostomy
Afghanistan
Iraq
Tourniquets
Hemostatics
Referral and Consultation
Blood Platelets
Catheters
Erythrocytes
Physicians
Surveys and Questionnaires

ASJC Scopus subject areas

  • Surgery

Cite this

Military-to-civilian translation of battlefield innovations in operative trauma care Presented previously at the Pacific Coast Surgical Association 85th Annual Meeting, February 14-17, 2014, Dana Point, CA. / Haider, Adil H.; Piper, Lydia C.; Zogg, Cheryl K.; Schneider, Eric B.; Orman, Jean A.; Butler, Frank K.; Gerhardt, Robert T.; Haut, Elliott; Mather, Jacques P.; Mackenzie, Ellen J; Schwartz, Diane A.; Geyer, David W.; Dubose, Joseph J.; Rasmussen, Todd E.; Blackbourne, Lorne H.

In: Surgery, Vol. 158, No. 6, 01.12.2015, p. 1686-1695.

Research output: Contribution to journalArticle

Haider, AH, Piper, LC, Zogg, CK, Schneider, EB, Orman, JA, Butler, FK, Gerhardt, RT, Haut, E, Mather, JP, Mackenzie, EJ, Schwartz, DA, Geyer, DW, Dubose, JJ, Rasmussen, TE & Blackbourne, LH 2015, 'Military-to-civilian translation of battlefield innovations in operative trauma care Presented previously at the Pacific Coast Surgical Association 85th Annual Meeting, February 14-17, 2014, Dana Point, CA.', Surgery, vol. 158, no. 6, pp. 1686-1695. https://doi.org/10.1016/j.surg.2015.06.026
Haider, Adil H. ; Piper, Lydia C. ; Zogg, Cheryl K. ; Schneider, Eric B. ; Orman, Jean A. ; Butler, Frank K. ; Gerhardt, Robert T. ; Haut, Elliott ; Mather, Jacques P. ; Mackenzie, Ellen J ; Schwartz, Diane A. ; Geyer, David W. ; Dubose, Joseph J. ; Rasmussen, Todd E. ; Blackbourne, Lorne H. / Military-to-civilian translation of battlefield innovations in operative trauma care Presented previously at the Pacific Coast Surgical Association 85th Annual Meeting, February 14-17, 2014, Dana Point, CA. In: Surgery. 2015 ; Vol. 158, No. 6. pp. 1686-1695.
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abstract = "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.",
author = "Haider, {Adil H.} and Piper, {Lydia C.} and Zogg, {Cheryl K.} and Schneider, {Eric B.} and Orman, {Jean A.} and Butler, {Frank K.} and Gerhardt, {Robert T.} and Elliott Haut and Mather, {Jacques P.} and Mackenzie, {Ellen J} and Schwartz, {Diane A.} and Geyer, {David W.} and Dubose, {Joseph J.} and Rasmussen, {Todd E.} and Blackbourne, {Lorne H.}",
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T1 - Military-to-civilian translation of battlefield innovations in operative trauma care Presented previously at the Pacific Coast Surgical Association 85th Annual Meeting, February 14-17, 2014, Dana Point, CA.

AU - Haider, Adil H.

AU - Piper, Lydia C.

AU - Zogg, Cheryl K.

AU - Schneider, Eric B.

AU - Orman, Jean A.

AU - Butler, Frank K.

AU - Gerhardt, Robert T.

AU - Haut, Elliott

AU - Mather, Jacques P.

AU - Mackenzie, Ellen J

AU - Schwartz, Diane A.

AU - Geyer, David W.

AU - Dubose, Joseph J.

AU - Rasmussen, Todd E.

AU - Blackbourne, Lorne H.

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N2 - 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.

AB - 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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