“advances in military medicine: reaching the …...eric b. schoomaker, md, phd uniformed services...
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Eric B. Schoomaker, MD, PhD Uniformed Services University of the Health Sciences
Bethesda, MD
“Advances in Military Medicine: Reaching the Summit…and Remaining”
State of the Science Symposia Series: Advances in Military and Veteran Health Research from Post-911 Conflicts For Wounded, Injured, and Ill Veterans
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"Americans should not expect one battle, but a lengthy campaign, unlike any other we have ever seen.”
President George W. Bush Address to a Joint Session of Congress
September 20, 2001
“…the long war” GEN John Abizaid
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Preparations and Ongoing Improvements in
Warrior Protection & Care • Improvements in Warrior protection
• Improvements on the battlefield
– Better trained medics – Improved equipment – Far forward emergency & surgical care
• Improvements in in-theatre (tactical) evacuation
• Improvements in between-theatre (strategic) evacuation
• Improvements in the continuum of resuscitative, surgical, medical & nursing care
• Improvements in rehabilitative care and transition
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Protecting the Force
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Better trained medics--EMTs
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IFAK: Saved Countless Lives & Limbs
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NovoSeven Injectable Clotting Agent
HemCon Bandage
One of Army’s “Top Ten Greatest Inventions of 2005”
Combat Application Tourniquet (CAT)
QuikClot
Plasma:RBC Ratio Groups
% M
ortality
Borgman MA, et al, J Trauma. Oct 2007
P < 0.05
Mortality by Plasma:RBC Ratio
One of Army’s “Top Ten Greatest Inventions of 2004”
Combat Gauze
One of Army’s “Top Ten Greatest Inventions of 2008”
Better Field Medical Equipment
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Evacuation: Tactical and Strategic
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“ROLE 2” (<1 hour)
Current Operations: A Seamless Continuum of Care
Deployed Hospitals
Role 3
Since Sep 2001
CY 2014*
Total Patients Moved 199,000 6,901
Critical Care (CCATT) 10,200 152
CENTCOM 105,700 1,935 *from AMC/SGK as of 30 Sep 2014
“ROLE 3” (<24 hrs)
“ROLE 4” (24-72 hrs)
“ROLE 5” (3+ days)
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Transformed Strategic Evac System: One Trauma System… Three Continents… 7,000 miles…
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Joint Theatre Trauma System - Comprehensive Trauma Care
• Spans the spectrum from preventive measures, wounding, treatment through to rehabilitation and return to duty
• Systematic and integrated
• Focus not just on writing papers but on
functional products
• Knowledge-based as well as product-based
TRAUMA SYSTEMS TEAM: TRAUMA NURSE COORDINATORS
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* May 2008 DoD Data **3 June 2010 DoD Data
% Survivability O
ver Time
[Wounds Not Mortal / (Battle Deaths + Wounds Not Mortal)] * 100
69.7% 75.4%
86.5% 89.9%
Improved Survival Over Time
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0.00000
2.00000
4.00000
6.00000
8.00000
10.00000
12.00000
0.000%
5.000%
10.000%
15.000%
20.000%
25.000%
30.000%Cum KIA%
Cum DOW%
Cum CFR%
Cum Avg mISS
Produced by the Joint Theater Trauma Registry Data Source: JTTR v.3 data extract supplemented by data provided by DMDC Statistical Analysis Division & US Pentagon OSD
Month / Year
Died of Wounds Rate Remained Stable Despite Steadily Rising Military Injury Severity Scores
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“To stay a Warrior…”
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Rest atop the summit…
…and reflect on the route that got you there.
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https://www.youtube.com/watch?v=IRCgaUcLA8A
How Did We Get to the Summit?
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What are our remaining challenges?
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OIF Mental Health Advisory Team: Dwell-Time is Critical
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PTSD N=232 68.2% 2.9%
16.5%
42.1%
6.8%
5.3%
10.3%
12.6%
TBI N=227 66.8%
Chronic Pain N=277 81.5%
The intersection of mind & body
Prevalence of Chronic Pain, PTSD and TBI in a sample of 340 OEF/OIF veterans with polytrauma
Lew, Otis, Tun et al., (2009). Prevalence of Chronic Pain, Post-traumatic Stress Disorder and Post-concussive Symptoms in OEF/OIF Veterans: The Polytrauma Clinical Triad. JRRD.
Slide 20
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Trauma Spectrum Response
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Rising Musculoskeletal & Mental Disorders—Ambulatory Visits
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Rising Hospitalizations for Mental Disorders
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(JAN-SEP ONLY)
Increasing Combat TBI Cases
2000
9000 10000 10,963
20,199 27,507
20000
6,282 (27%)
7,135 (26%)
4,133 (20%)
2007 2008 2009 DoD Baseline DoD OIF/OEF DoD OIF/OEF DoD OIF/OEF
DoD Total
Data Source: AFHSC
Deployed Forces 23,002
OVERALL TBI CASES HAVE MORE THAN DOUBLED
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Prescription Opioids
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An Epidemic in Opioid Problems in the US
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– Provide recommendations for a MEDCOM comprehensive pain management strategy that is holistic, multidisciplinary, and multimodal in its approach, utilizes state of the art/science modalities and technologies, and provides optimal quality of life for Soldiers and other patients with acute and chronic pain.
– Relieving Pain in America: A Blueprint for
Transforming Prevention, Care, Education and Research
DoD Pain Management Task Force
Institute of Medicine
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Comprehensive Pain Management
Evidence-Based Complementary and Alternative Therapeutic Modes
Acupuncture Biofeedback Yoga Meditation
Standardizes Pain Management Services at echelons of care across our Medical Treatment Facilities: Team-Based
Provides optimal quality of life for Soldiers and patients with acute and chronic pain
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2009/2010 2011/2012 2013 2014 2015
Pain Management Task Force Report
NCCIH: Strengthening Collaborations w/ DoD and VA: Effectiveness Research on Mind/Body Interventions
National Pain Strategy
MHS Review IOM “Pain in America” Report
VHA Pain Mgt Directive 2009-053
DoD Pain Mgt Task Force
NIH Interagency Pain Research Coordinating Committee
VHA Pain Program Office
Institutes of Medicine as directed by
Affordable Care Act
NCCIH Council Working Group
Military Health System
Federal Initiatives Supporting Complementary & Integrative Medicine Pain Management
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Post-Pain Task Force major lines of effort
Defense and Veterans Pain Rating Scale (DVPRS) – New DoD pain scale
Extension for Community Healthcare Outcomes (ECHO) – Pain knowledge network
Interdisciplinary Pain Management Centers (IPMC) – Integrative Pain Clinics
PASTOR/PROMIS-Patient Assessment Tool and Outcomes Registry
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EDUCATION INFRASTRUCTURE SOCIETAL PRIORITIES
Critical to Business Success
HEALTHCARE
Essential to the Creation of Health
Waste $750 Billion
Markets $
Goods / Services
Macro Economic Concept Model
Cathy Baase, M.D. • The Dow Chemical Company • July 30, 2014 32
30%
10%
40% 20%
Health Behaviors
Clinical Care
Social & Economic Factors
Physical Environment
Health Factors
Positive Health Outcomes • Performance and Productivity • Safety • Attract and Retain Talent • Engagement and Satisfaction • Sustainability and Reputation
$
Business (Generates $)
Employee Wages
Common Resource Pool % of Gross Domestic Product
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• Leadership • Vision • Culture • Guiding Principles • Alignment • Teamwork
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Thank you! Questions?