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

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 2 CDC, 2007

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) 3 AHRQ, 2005

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 4

Civilian Trauma Research Gaps 1. 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 5

Civilian Trauma Research Gaps 2. Intensive Care  Tracheostomy in patients requiring prolonged mechanical ventilation  Prevention of thromboembolic occurrences and complications  Increasing ventilator-free days and lowering costs and complications 6

Civilian Trauma Research Gaps 3. Burn  Replacement and off-the-shelf skin  Protecting skin grafts from immune recognition  Pain management 7

Civilian Trauma Research Gaps 4. Hospital Acquired Infection and Antibiotic Utilization  Rapid methods for detection and identification of infection  Methods for minimization of transmission 8

Civilian Trauma Research Gaps 5. Disaster Preparedness  Procedures or treatment in mass casualty situations  Safe and cost-effective transport protocols for critically injured patients 9

Civilian Trauma Research Gaps 6. 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 10

Military/Civilian Common Challenges Hemorrhage/coagulopathyBurn Wound infectionHospital-acquired infection Transportation of the critically illDisaster preparednessOrthopaedic traumaTBI Pain managementIntensive Care Secondary cell and organ damageTechnology development Massive soft tissue injury Eye, ear, craniofacial injury Pre-hospital data 11  Military  Civilian

Research Gaps - Conclusion  We’re 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 12