Military-Civilian Partnerships in Trauma Skills Training

Until the 21st century, approximately 90% of combat-related deaths occurred before a casualty arrived at a medical treatment facility. Three major potentially survivable causes of death are extremity hemorrhage exsanguination, tension pneumothorax, and airway obstruction. According to JAMA Surgery, in an analysis of all US military casualties from October 2001 through December 2017 (Operation Iraqi Freedom, Operation Enduring Freedom), researchers found that survival among the most critically injured casualties increased 3-fold during the course of those respective conflicts and that three key interventions, tourniquets, blood transfusions, and prehospital transport within 60 minutes, were associated with 44% of mortality reduction. This finding led to multiple innovations in state-of-the-art trauma training for our military that would further curtail battlefield mortality.

In 2017 the National Defense Authorization Act initiated a directive for the Military Health System to establish partnerships with civilian institutions to obtain and sustain trauma care competency accompanied by standardized combat care instruction to enhance quality of care outcomes for trauma care. Since the US pivoted away from the Middle East, MISSION ZERO was signed into law as part of the Pandemic and All-Hazards Preparedness and Advancing Innovation Act. In case you were wondering, funding is authorized. A congressional sign-on letter that fifteen U.S. senators advocated for convinced a U.S. Senate Appropriations Subcommittee to earmark $11.5 million in FY 2022 funding for the Military and Civilian Partnership and Trauma Readiness Grant Program. Furthermore, the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) submitted statements to House and Senate appropriators also urging funding.

The Military Health System consists of Army, Air Force, and Naval medical personnel who currently engage in partnerships with civilian healthcare systems all over the US. Perhaps you have encountered these partnerships in your own practice. Maybe you have worked alongside an Army nurse in your  ED or OR on a polytrauma patient or taught an Air Force medical technician how to measure intracranial pressure in your ICU, or instructed a Navy Corpsman how to change dressings on an open GSW. Perchance you worked with an Army, Air Force, or Navy trauma surgeon in one of many affiliations that include Cooper University Healthcare in Camden, NJ, Oregon Health and Sciences Center in Portland, OR, Penn Presbyterian Medical Center, Philadelphia, PA, Cook County Health in Chicago IL, Cincinnati Medical Center UC Health, Cincinnati, OH, the University of Nebraska Medical Center, Omaha, NE, Soin Medical Center, Beavercreek, OH, R. Adams Cowley Shock Trauma Center, Baltimore, MD, Grady Memorial Trauma Center, Atlanta, GA, St. Louis University Hospital, Cardinal Glennon Children's and Mercy Medical Center, in St. Louis, MO and The University of Las Vegas Medical Center, Las Vegas, NV. These are only a handful of the institutions that entered into partnerships with the Military Health System.

Military medical treatment facilities lack the acuity and volume medical servicemembers need to sustain operational readiness to deploy downrange and provide high-quality care to our injured heroes. AMCT3 (Army Military-Civilian Trauma Team Training) and the Air Force C-STARS (Center for the Sustainment of Trauma and Readiness Skills) are premiere programs that give servicemembers clinical immersion in a level 1 trauma center that they cannot obtain working in their military medical treatment facilities. Base populations are generally healthy, and they're not going to see poly traumas, GSWs, and tension pneumothorax in their troop medical clinics and community hospitals.

If you encounter them on your unit, it helps to know that military medical technicians are highly trained to the level of licensed practical nurses. They possess NR-EMT certifications and receive classroom, clinical, and field medical training before they begin working at their permanent duty stations. Many of them possess advanced certifications and college degrees.

Physicians, nurses, medical technicians, respiratory technicians, OR technicians, and Special Operations medics participate in clinical rotations that include areas such as the ED, OR and ICUs. The programs also consist of didactics, high-definition sim lab scenarios and cadaver lab workshops. They experience live telemedicine conferencing with military personnel in field hospitals overseas and can track a casualty during the en-route care transport system all the way back to our US hospitals.

Recent news garnered attention for USAF surgeon Lt.Col. Valerie Sams, who was part of the team at UC Health's University of Cincinnati Medical Center that cared for Buffalo Bills' safety, Damar Hamlin, the night his heart stopped on the field. Dr. Sams is the director of the C-STARS program at Cincinnati and trains Air Force medics attending an advanced course in Critical Care Air Transport (CCAT). Air Force physicians that administer the program are embedded in the faculty and staff. They see patients and take call as attending physicians while training military medical personnel. Every hospital that engages in these partnerships further embodies the tenets of its mission.

If you work in these settings, maybe you never realized you are providing our armed forces with valuable experience as well as hopefully taking something away for yourself in an exchange of ideas and knowledge that is unique and gratifying. You are contributing to the reduction in battlefield mortality. Support and expansion of these programs are imperative for the Military Health System to maintain operational readiness. The military and civilian men and women who administer these programs have a personal, vested interest and love what they do. Military-Civilian partnerships will soon be a mainstay in US healthcare. Your support is a gift.

Rosemarie Tracy, RN, BSN

References/Resources

Building a sustainable Mil-Civ partnership to ensure a ready medical force: A single partnership site's experience: National Library of Medicine-PubMed

Military trauma training at civilian centers: a decade of advancements: National Library of Medicine-PubMed

Eliminating Preventable Death on the Battlefield: American Medical Association-JAMA Network

Use of Combat Casualty Care Data to Assess the US Military Trauma System During the Afghanistan and Iraq Conflicts, 2001-2017: National Library of Medicine-PubMed

From the battlefield to the football field: Air Force surgeon's skills knows no bounds: Airforce Medical Service

Senators Champion Funding for Military-Civilian Trauma Program: American Association of Neurological Surgeons