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Battlefield Trauma Lessons Can Save Americans at Home

Faster care might prevent 30,000 civilian deaths each year, especially when it comes to shootings like Orlando.

The aftermath of mass shootings such as the one in Orlando, Fla., can look like a war zone. Now a panel of medical experts says the lessons the U.S. military has learned over the past 15 years by treating trauma on the battlefield in Afghanistan and Iraq can save tens of thousands of lives at home.

Traumatic injuries, from vehicle crashes to gunshot wounds, are the leading cause of death for Americans under 46, according to a new report published Friday by a committee from the National Academies of Sciences, Engineering, & Medicine. Those injuries have killed 2 million Americans since 2001. The panel estimates that as many as one in five trauma deaths could be prevented with better care, saving 30,000 lives a year.

The committee identified “a number of important and badly needed changes in trauma care” and called for the White House to lead the integration of military and civilian trauma-care systems. The goal is to make sure the best practices get applied consistently, both across the military and in civilian settings, and to help the medical system institutionalize the lessons from wartime medicine. Getting military medical staff to rotate regularly into civilian hospitals was a key recommendation in the report.

Bringing their experience to bear could improve the odds for people wounded daily in car crashes and falls. It may also prepare the medical system better for mass casualty events like last weekend's massacre in Florida. Some of the surviving victims of the attack likely owe their lives to the fact that the nightclub targeted was blocks from a major trauma center. Survivors of last year’s Paris attacks and the 2013 Boston Marathon bombing likewise benefited because prepared emergency medical personnel, some with battlefield experience, were close by. One indicator of medical advances in the trauma arena was the precipitous drop, in these attacks, of injured who later died.

"The tragedy is that a lot of this likely could be helped by that hard-won knowledge gained on the battlefield,” said John B. Holcomb, a retired colonel and chairman of surgery at the University of Texas Health Science Center, who served on the committee. "No one knows where the next Orlando is going to happen."

In the Vietnam War, 23 percent of wounded troops died from their injuries. In the recent conflicts in Iraq and Afghanistan, that rate was down to 9 percent. That improvement was driven by military leaders “determined to save lives by avoiding the mistakes of the past,” the report says.

The lessons need to be applied consistently across the military, too. About 1,000 service members who died on the battlefield between 2001 and 2011 might have been saved with better trauma care—a quarter of all battlefield deaths, according to the report.

The report calls for a number of systematic changes, including better sharing of data and research. There are some practical steps, too, such as using tourniquets more aggressively and strengthening the role of “prehospital” care, such as emergency medical technicians. “Prehospital care tends to be treated too much as transportation,” said Donald Berwick, former administrator of the Centers for Medicare and Medicaid and chairman of the committee.

The group also envisions having military doctors and medics working regularly in stateside trauma centers. That could strengthen care in the U.S. It could also help responders in the armed forces prepare to treat casualties in peacetime. 

"Our fear and our belief is that when war ends, as we hope it does, that skills get lost,” said David Marcozzi, an associate professor of emergency medicine at the University of Maryland School of Medicine.

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