Better Care Could Prevent 20% of Trauma Injury Deaths: Report

The findings of new research suggests that up to one out of every five trauma deaths in the United States may be prevented if better care was provided. 

Researchers with the National Academies of Sciences, Engineering and Medicine recently conducted a study looking at both civilian and military trauma care systems nationwide, and found that when and where an individual is injured greatly impacts the quality of care they receive. According to a press release issued to announce the findings, the difference in treatment quality following a trauma is often the difference between life and death.

According to the report, a disabling or life-threatening physical injury, referred to as a trauma, is the leading cause of death among Americans under the age of 46. In 2014, there were 147,790 U.S. trauma deaths, and the study indicates that about 30,000 could have been prevented with better care.

The researchers note that there have been significant advances in trauma care over the last 10 years, driven largely by military trauma experiences in the wars in Iraq and Afghanistan.

Fatalities among wounded service members in the military dropped 50% from 2005 to 2013 due to those advancements and better understanding of how to treat trauma, and the report indicates that those advances should be more quickly integrated into civilian handling of trauma injuries such as gun shots, falls leading to traumatic brain injuries and other injuries, and auto accidents.

“Both the military and civilian sectors have made impressive progress and important innovations in trauma care, but there are serious limitations in the diffusion of those gains from location to location,” Committee Chair Donald Berwick, president emeritus and senior fellow at the Institute for Healthcare Improvement in Cambridge, Massachusetts, said in the press release. “Even as the successes have saved many lives, the disparities have cost many lives. With the decrease in combat and the need to maintain readiness for trauma care between wars, a window of opportunity now exists to integrate military and civilian trauma systems and view them not separately, but as one.”

The committee called for a cohesive national strategy to address trauma care, noting that mortality rates among trauma victims vary widely from one trauma center to another, and that much of the opportunity to save lives comes based on the care provided by first-responders, perhaps more so than by doctors in many cases.

“[Emergency medical Services (EMS)] is a disjointed set of systems across the nation with differing standards of care and few universal protocols,” the press release states. ” Additionally, the Centers for Medicare & Medicaid Services (CMS) reimburses EMS as a supplier of transportation to a medical facility, based on factors such as the miles traveled to an emergency department and the level of care provided while en route, rather than as a health care provider. Essentially, EMS agencies are discouraged from determining the need for transport to a hospital given that payers will deny reimbursement if such transport does not occur.”

The committee called for EMS to be seen as a form of pre-hospital care instead of just a transport service, and called for appropriate changes to how EMS providers are reimbursed.

The report calls for military trauma personnel to work in civilian facilities during peacetime to both pass on battlefield trauma knowledge and to keep their skills honed when the military is not dealing with large numbers of trauma cases. It also called for the establishment of more military trauma centers, noting that there are only three in the entire United States.

Such a coordination of trauma services on a national level could only be directed by the White House, the report noted.